Provider Demographics
NPI:1881832640
Name:BACK TO BASICS BEHAVIORAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BACK TO BASICS BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-651-4295
Mailing Address - Street 1:44 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027-3347
Mailing Address - Country:US
Mailing Address - Phone:207-651-4295
Mailing Address - Fax:207-457-6056
Practice Address - Street 1:44 DEPOT RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:ME
Practice Address - Zip Code:04027-3347
Practice Address - Country:US
Practice Address - Phone:207-651-4295
Practice Address - Fax:207-457-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-31
Last Update Date:2009-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECS1-11-963251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432442400Medicaid