Provider Demographics
NPI:1558839969
Name:OHI
Entity type:Organization
Organization Name:OHI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:A/R ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRANGWYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-605-1198
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:207-605-1198
Mailing Address - Fax:
Practice Address - Street 1:412 HIGH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2509
Practice Address - Country:US
Practice Address - Phone:207-605-1208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-05
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health