Provider Demographics
NPI:1457426561
Name:OHI
Entity Type:Organization
Organization Name:OHI
Other - Org Name:COMMUNITY SUPPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-605-1256
Mailing Address - Street 1:203 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4331
Mailing Address - Country:US
Mailing Address - Phone:207-848-5804
Mailing Address - Fax:207-989-4050
Practice Address - Street 1:203 MAINE AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4331
Practice Address - Country:US
Practice Address - Phone:207-848-5804
Practice Address - Fax:207-848-7978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME230521251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109800100Medicaid