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Organization
WIDE BEHAVIOR SERVICES LLC
Active
Organization
WIDE BEHAVIOR SERVICES LLC
Active
Other names
WIDE BEHAVIOR SERVICES LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH SHUMBUSHO (CEO)
(207) 632-5106
Entity
Organization
Contact information
Practice address
4 APPLE TREE LN, SACO, ME 04072-8830
(207) 632-5106
Mailing address
4 APPLE TREE LN, SACO, ME 04072-8830
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
—
—
261Q00000X
Clinic/Center
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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