1427121243 NPI number — OHI

Table of content: (NPI 1427121243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427121243 NPI number — OHI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOME BASED WAIVER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427121243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 MAINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04401-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-848-5804
Provider Business Mailing Address Fax Number:
207-989-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 MAINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-4331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-848-5804
Provider Business Practice Location Address Fax Number:
207-989-4050
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
207-605-1256

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109800220 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800204 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800214 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800217 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800216 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800205 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800213 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800219 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800206 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800208 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800201 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800207 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800209 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800215 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109800200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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