CITY OF PORTLAND

NPI # 

Practice Address:

39 Forest Ave

Portland, ME, 04101-2912

Practice Phone:

207-874-8446

License Number:

H80CS00005-04-00

License State:

ME

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Federally Qualified Health Center (FQHC)

Taxonomy Code:

261QF0400X