Basic Information
| Provider Information | |||||||||
| NPI: | 1215940523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACADIA HOSPITAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 422 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044020422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079736470 | ||||||||
| FaxNumber: | 2079736109 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 STILLWATER AVENUE | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079736470 | ||||||||
| FaxNumber: | 2079736109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2079736100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 36303 | ME | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 3251291 | 01 | AETNA | OTHER |