MEDICARE: SENECA BEHAVIORAL HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1427414473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENECA BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	PO BOX 11562
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04104-7562
Country	:	US
Telephone Number	:	207-956-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 BISHOP ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-2681
Country	:	US
Telephone Number	:	207-956-5111
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KENNETH OLSON
Credential	:
Telephone Number	:	207-956-5111

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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