Healthcare Provider Details

I. General information

NPI: 1255248902
Provider Name (Legal Business Name): MHT-VISION SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LANGLEY ST
BANGOR ME
04401-2816
US

IV. Provider business mailing address

45 LANGLEY ST
BANGOR ME
04401-2816
US

V. Phone/Fax

Practice location:
  • Phone: 917-436-5147
  • Fax:
Mailing address:
  • Phone: 917-436-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOEL MUHETO
Title or Position: OWNER
Credential:
Phone: 917-436-5147