Provider Demographics
NPI:1851432041
Name:NEW LIFE MISSION
Entity Type:Organization
Organization Name:NEW LIFE MISSION
Other - Org Name:BANGOR COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-941-6434
Mailing Address - Street 1:202 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6508
Mailing Address - Country:US
Mailing Address - Phone:207-941-6434
Mailing Address - Fax:207-941-9366
Practice Address - Street 1:202 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6508
Practice Address - Country:US
Practice Address - Phone:207-941-6434
Practice Address - Fax:207-941-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME392936251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME121150001Medicaid
ME121150100Medicaid
MEMM9512Medicare PIN