Provider Demographics
NPI:1457691263
Name:ANGLEZ BEHAVIORAL HEALTH SERVICES PA
Entity Type:Organization
Organization Name:ANGLEZ BEHAVIORAL HEALTH SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-294-5306
Mailing Address - Street 1:841 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8302
Mailing Address - Country:US
Mailing Address - Phone:844-294-5306
Mailing Address - Fax:844-294-5306
Practice Address - Street 1:841 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8302
Practice Address - Country:US
Practice Address - Phone:844-294-5306
Practice Address - Fax:844-294-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME658709251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME016000001Medicaid