Healthcare Provider Details

I. General information

NPI: 1588720866
Provider Name (Legal Business Name): COMMUNITY HEALTH AND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR ST
BANGOR ME
04402-0425
US

IV. Provider business mailing address

42 CEDAR ST PO BOX 425
BANGOR ME
04402-0425
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax:
Mailing address:
  • Phone: 207-947-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number02790
License Number StateME

VIII. Authorized Official

Name: DALE HAMILTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-947-0366