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General NPI Number Information
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NPI Number | 1992096515
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Entity Type | Organization
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Legal Business Name | MAINE BEHAVIORAL HEALTH ORGANIZATION
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 203 NORTH RD
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City | ATHENS
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State | ME
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Zip | 04912-4004
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Country | US
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Telephone | 207-654-2429
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Fax |
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Provider Business Mailing Address
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Address Line | 49 OAK ST
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City | AUGUSTA
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State | ME
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Zip | 04330-5118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HILLARY KIMBALL-WHITE
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Credential |
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Telephone | 207-399-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 623004
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License Number State | ME
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