Provider Demographics
NPI:1346499787
Name:BANGOR AREA HOMELESS SHELTER
Entity Type:Organization
Organization Name:BANGOR AREA HOMELESS SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-947-0045
Mailing Address - Street 1:P.O. BOX 1754
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1754
Mailing Address - Country:US
Mailing Address - Phone:207-947-0045
Mailing Address - Fax:207-945-9032
Practice Address - Street 1:263 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04402-1754
Practice Address - Country:US
Practice Address - Phone:207-947-0045
Practice Address - Fax:207-945-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME405340000Medicaid