Provider Demographics
NPI:1376236695
Name:MAINE COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:MAINE COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHANKWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-249-3307
Mailing Address - Street 1:8 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1493
Mailing Address - Country:US
Mailing Address - Phone:207-746-0039
Mailing Address - Fax:
Practice Address - Street 1:8 FLEMING ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1493
Practice Address - Country:US
Practice Address - Phone:207-746-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health