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NPI Code Detail

MEDICARE: BECKET MAINE INC.

MEDICARE: BECKET MAINE 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
1320800000XMental Illness Community Based Residential Treatment Facility
2322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1760226245
Entity Type Code : Organization
Provider Name (Legal Business Name) : BECKET MAINE INC.
Provider Business Mailing Address
First Line : PO BOX 325
Second Line :
City : ORFORD
State : NH
Zip : 03777-0325
Country : US
Telephone Number : 603-353-9102
Fax Number : 603-353-9412
Provider Business Practice Location Address
First Line : 744 OAKLAND RD
Second Line :
City : BELGRADE
State : ME
Zip : 04917-3411
Country : US
Telephone Number : 603-353-9102
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JAY WOLTER
Credential :
Telephone Number : 603-353-9102
Provider Enumeration Date : 06/20/2024
Last Update Date : 06/20/2024

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