Doctor Name: | MR. RANDALL S ROBERTS |
NPI Number: | 1649404609 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 52 Gardner Street Apt A Patten, ME - 04765 |
Business Phone Number: | 2075385279 |
Business Fax Number: | |
Mailing Address: | Po Box 226, PATTEN |
State: | ME |
Postal Code: | 047650226 |
Phone Number: | 2075385279 |
Fax Number: | |
NPI Enumeration Date: | 05/06/2009 |
NPI Last Update Date: | 05/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |