Provider Demographics
NPI:1568901908
Name:USA FAMILY WELL BEING SERVICES LLC
Entity Type:Organization
Organization Name:USA FAMILY WELL BEING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:KABBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER, PUBLIC HEALT
Authorized Official - Phone:207-415-5081
Mailing Address - Street 1:500 FOREST AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1520
Mailing Address - Country:US
Mailing Address - Phone:207-699-4470
Mailing Address - Fax:207-699-4471
Practice Address - Street 1:500 FOREST AVE STE 6
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1520
Practice Address - Country:US
Practice Address - Phone:207-699-4470
Practice Address - Fax:207-699-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management