Organization
STATE OF MAINE
Active
Other names
Dorothea Dix Psychiatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL WEBB CODY (FINANCIAL MANAGER)
(207) 941-4192
Entity
Organization
Contact information
Practice address
656 STATE ST, BANGOR, ME 04401-5609
(207) 941-4192
Mailing address
109 CAPITOL STREET, STATE HOUSE STATION #11, REIMBURSEMENT UNIT, AUGUSTA, ME 04330-6846
(207) 287-7418
(207) 287-1862
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003288
BLUE CROSS
ME
05
—
135910900
—
ME
Enumeration date
08/09/2005
Last updated
06/17/2019
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