Healthcare Provider Details

I. General information

NPI: 1972503365
Provider Name (Legal Business Name): ALTERNATIVE HEALTH SERVICES OF ST. JOSEPH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BROADWAY BLDG 4
BANGOR ME
04401-1900
US

IV. Provider business mailing address

PO BOX 934
BANGOR ME
04402-0934
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-1810
  • Fax: 207-907-1928
Mailing address:
  • Phone: 413-406-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number38335
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number36863
License Number StateME

VIII. Authorized Official

Name: MR. MICHAEL HENDRIX
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 207-907-1600