Nichole Lavalley
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Jackson, ME. Individual provider (NPI-1).
NPI number1821138017
StatusActive
Last updated in NPPESOct 30, 2019
Details
- NPI
- 1821138017
- Entity type
- Individual (NPI-1)
- Name
- Nichole Lavalley
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 7, 2007
- Last updated
- Oct 30, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ALLS 2297 | ME | Yes |
Practice location
1461 Moosehead TrlJackson, ME 04921
Phone 207-907-2631
Mailing address
119 Lower Detroit RdPlymouth, ME 04969-3213
Other practice locations
119 Lower Detroit Rd
Plymouth, ME 04969-3213
Plymouth, ME 04969-3213
Phone 207-257-2131
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