Provider Demographics
NPI:1891876751
Name:ELMHURST, INC
Entity Type:Organization
Organization Name:ELMHURST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-443-9783
Mailing Address - Street 1:400 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2007
Mailing Address - Country:US
Mailing Address - Phone:207-443-9783
Mailing Address - Fax:207-443-8887
Practice Address - Street 1:400 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2007
Practice Address - Country:US
Practice Address - Phone:207-443-9783
Practice Address - Fax:207-443-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103060301Medicaid
ME103060303Medicaid
ME103060000Medicaid
ME103060304Medicaid
ME103060200Medicaid
ME103060100Medicaid
ME103060300Medicaid
ME103060202Medicaid
ME103060302Medicaid