Healthcare Provider Details

I. General information

NPI: 1679087175
Provider Name (Legal Business Name): MINDS FOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15A WESTMINISTER STREET
LEWISTON ME
04240-7235
US

IV. Provider business mailing address

PO BOX 194
LEWISTON ME
04243-0194
US

V. Phone/Fax

Practice location:
  • Phone: 207-753-2688
  • Fax: 207-753-2788
Mailing address:
  • Phone: 207-753-2688
  • Fax: 207-753-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateME

VIII. Authorized Official

Name: JIHAN OMAR ABDI
Title or Position: CEO
Credential:
Phone: 207-332-1936