| Organization Name: | THE MAINE FITNESS STORE, INC |
| NPI Number: | 1225280597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY N LEACH (PRESIDENT) |
| Mailing Address: | 849 Stillwater Ave Suite 1 Bangor |
| State: | ME US |
| Postal Code: | 044013624 |
| Phone Number: | 2079904552 |
| Fax Number: | 2079904552 |
| NPI Enumeration Date: | 10/18/2008 |
| NPI Last Update Date: | 10/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |