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165 Lancaster St Portland ME 04101-2406 | |
| (207) 874-1030 | |
| (207) 874-1044 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 165 Lancaster St, Portland, Maine |
| Authorized Official Name and Position | Greg Bowers (EVP & COO) |
| Authorized Official Contact | 2072532629 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
78 Atlantic Place South Portland ME 04106-2316 Ph: (207) 842-7701 | 165 Lancaster St Portland ME 04101-2406 Ph: (207) 874-1030 |
| NPI Number | 1962422964 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 06/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962422964 | NPI | - | NPPES |
| 104760000 | Medicaid | ME | |
| 104760001 | Medicaid | ME | |
| 104760201 | Medicaid | ME | |
| 104760100 | Medicaid | ME | |
| 14760200 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 680905 (Maine) | Primary |
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