Provider Demographics
NPI:1700077179
Name:AROOSTOOK MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:AROOSTOOK MENTAL HEALTH SERVICES, INC.
Other - Org Name:AMHC - CENTER FOR INTERGRATED NEURO REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DISY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-498-6431
Mailing Address - Street 1:7 RUSS STREET
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2213
Mailing Address - Country:US
Mailing Address - Phone:207-498-2528
Mailing Address - Fax:207-492-3181
Practice Address - Street 1:7 RUSS STREET
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2213
Practice Address - Country:US
Practice Address - Phone:207-498-2528
Practice Address - Fax:207-492-3181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AROOSTOOK MENTAL HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPROVISIONAL261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)