Provider Demographics
NPI:1447693965
Name:CHARETTE PRIMARY HEALTH CARE
Entity type:Organization
Organization Name:CHARETTE PRIMARY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARETTE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:207-316-4655
Mailing Address - Street 1:35 CARSON LN
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1474
Mailing Address - Country:US
Mailing Address - Phone:207-398-1022
Mailing Address - Fax:207-764-6504
Practice Address - Street 1:1063 ALLAGASH RD STE 1
Practice Address - Street 2:
Practice Address - City:ALLAGASH
Practice Address - State:ME
Practice Address - Zip Code:04774-4010
Practice Address - Country:US
Practice Address - Phone:207-398-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care