Provider Demographics
NPI:1457415184
Name:COMMUNITY HEALTH AND COUNSELING SERVICES
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-947-0366
Mailing Address - Street 1:42 CEDAR STREET
Mailing Address - Street 2:PO BOX 425
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0425
Mailing Address - Country:US
Mailing Address - Phone:207-947-0366
Mailing Address - Fax:
Practice Address - Street 1:42 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04402
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH AND COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME220861251S00000X, 261QM0801X, 320800000X
261QM1300X, 261QP2300X
ME214394322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101750000Medicaid
MEATOOtherANTHEM
MECB4118OtherRAILROAD MEDICARE
ME101750000Medicaid