Healthcare Provider Details

I. General information

NPI: 1891876751
Provider Name (Legal Business Name): ELMHURST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CENTRE ST
BATH ME
04530-2007
US

IV. Provider business mailing address

400 CENTRE ST
BATH ME
04530-2007
US

V. Phone/Fax

Practice location:
  • Phone: 207-443-9783
  • Fax: 207-443-8887
Mailing address:
  • Phone: 207-443-9783
  • Fax: 207-443-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEX KAUTZMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-443-9783