Provider Demographics
NPI:1619171923
Name:BECKET ACADEMY INC.
Entity Type:Organization
Organization Name:BECKET ACADEMY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-353-9102
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:ORFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03777-0325
Mailing Address - Country:US
Mailing Address - Phone:603-353-9102
Mailing Address - Fax:603-353-9412
Practice Address - Street 1:744 OAKLAND RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-3411
Practice Address - Country:US
Practice Address - Phone:207-465-4600
Practice Address - Fax:207-465-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No253Z00000XAgenciesIn Home Supportive Care
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME143320006Medicaid
ME143320004Medicaid
ME143320000Medicaid
ME143320003Medicaid
ME143320005Medicaid
ME143320002Medicaid
ME143320001Medicaid