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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