Provider Demographics
NPI:1376642066
Name:MID-COAST MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:MID-COAST MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHUT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-701-4400
Mailing Address - Street 1:12 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2739
Mailing Address - Country:US
Mailing Address - Phone:207-701-4400
Mailing Address - Fax:207-701-4486
Practice Address - Street 1:12 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2739
Practice Address - Country:US
Practice Address - Phone:207-701-4400
Practice Address - Fax:207-701-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME231141251B00000X, 320600000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104000101Medicaid
ME104000100Medicaid
ME104000200Medicaid
ME104000102Medicaid
ME104000001Medicaid
ME104000000Medicaid
ME104000102Medicaid