Provider Demographics
NPI:1659763696
Name:CASCO BAY COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:CASCO BAY COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MIHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MHRT-C
Authorized Official - Phone:207-899-8648
Mailing Address - Street 1:2 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1125
Mailing Address - Country:US
Mailing Address - Phone:207-899-8648
Mailing Address - Fax:
Practice Address - Street 1:2 FOREST CIR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1125
Practice Address - Country:US
Practice Address - Phone:207-899-8648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME683108251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health