| State Of Maine | |
|
656 State St Bangor ME 04401-5609 | |
| (207) 287-7418 | |
| (207) 287-1862 |
| Full Name | State Of Maine |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 656 State St, Bangor, Maine |
| Authorized Official Name and Position | Carol Webb Cody (FINANCIAL MANAGER) |
| Authorized Official Contact | 2079414192 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Maine 109 Capitol Street Shs #11, Reimbursement Unit Augusta ME 04333-0011 Ph: (207) 287-7418 | State Of Maine 656 State St Bangor ME 04401-5609 Ph: (207) 287-7418 |
| NPI Number | 1184020091 |
|---|---|
| Provider Enumeration Date | 11/05/2014 |
| Last Update Date | 06/14/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184020091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 681294 (Maine) | Primary |
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