Provider Demographics
NPI:1588720866
Name:COMMUNITY HEALTH AND COUNSELING SERVICES
Entity type:Organization
Organization Name:COMMUNITY HEALTH AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-947-0366
Mailing Address - Street 1:42 CEDAR ST
Mailing Address - Street 2:PO BOX 425
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0425
Mailing Address - Country:US
Mailing Address - Phone:207-947-0366
Mailing Address - Fax:
Practice Address - Street 1:42 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04402-0425
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH AND COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02790251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEBD2OtherANTHEM (HH)
ME101750301Medicaid
ME207026Medicare ID - Type UnspecifiedMEDICARE PART A-HH