Organization
BACK TO BASICS BEHAVIORAL HEALTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY PAUL GROVER (CEO)
(207) 651-4295
Entity
Organization
Contact information
Practice address
44 DEPOT RD, LEBANON, ME 04027-3347
(207) 651-4295
(207) 457-6056
Mailing address
44 DEPOT RD, LEBANON, ME 04027-3347
(207) 651-4295
(207) 457-6056
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
CS1-11-963
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432442400
—
ME
Enumeration date
01/31/2009
Last updated
01/31/2009
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