Provider Demographics
NPI:1255462636
Name:AREA IV MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:AREA IV MENTAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-795-6710
Mailing Address - Street 1:PO BOX 1319
Mailing Address - Street 2:12 BATES ST
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-1319
Mailing Address - Country:US
Mailing Address - Phone:207-795-6710
Mailing Address - Fax:207-795-6714
Practice Address - Street 1:12 BATES ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7604
Practice Address - Country:US
Practice Address - Phone:207-795-6710
Practice Address - Fax:207-795-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME220701251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME116230000Medicare ID - Type UnspecifiedMAINECARE