Healthcare Provider Details

I. General information

NPI: 1457691263
Provider Name (Legal Business Name): ANGLEZ BEHAVIORAL HEALTH SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 RIVERSIDE DR
AUGUSTA ME
04330-8302
US

IV. Provider business mailing address

841 RIVERSIDE DR
AUGUSTA ME
04330-8302
US

V. Phone/Fax

Practice location:
  • Phone: 844-294-5306
  • Fax: 844-294-5306
Mailing address:
  • Phone: 844-294-5306
  • Fax: 844-294-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number658709
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number658709
License Number StateME

VIII. Authorized Official

Name: ANNALEE MORRIS
Title or Position: CEO
Credential:
Phone: 844-294-5306