Healthcare Provider Details

I. General information

NPI: 1578911830
Provider Name (Legal Business Name): ACADIA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 STILLWATER AVE
BANGOR ME
04401-3945
US

IV. Provider business mailing address

268 STILLWATER AVE
BANGOR ME
04401-3945
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6100
  • Fax:
Mailing address:
  • Phone: 207-973-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLC14021
License Number StateME

VIII. Authorized Official

Name: RHONDA WILLIAMS
Title or Position: CLINICAL OPERATIONS SUPPORT SPECIAL
Credential: BS
Phone: 207-973-7530