Provider Demographics
NPI:1124160171
Name:AMICUS
Entity type:Organization
Organization Name:AMICUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GODSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-941-2892
Mailing Address - Street 1:96 THIRTEENTH STREET
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-941-2892
Mailing Address - Fax:207-941-2888
Practice Address - Street 1:96 13TH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4538
Practice Address - Country:US
Practice Address - Phone:207-941-2892
Practice Address - Fax:207-941-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME431573400251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE55026OtherSALES TAX EXEMPTION