Provider Demographics
NPI:1811303373
Name:BEHAVIORAL HEALTH RESOURCES OF MAINE INC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH RESOURCES OF MAINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-808-1384
Mailing Address - Street 1:305 COMMERCIAL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4641
Mailing Address - Country:US
Mailing Address - Phone:207-808-1384
Mailing Address - Fax:207-221-1710
Practice Address - Street 1:305 COMMERCIAL ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4641
Practice Address - Country:US
Practice Address - Phone:207-808-1384
Practice Address - Fax:207-767-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-06
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2233101YA0400X
MECNP81017363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMETPID005674Medicaid