| NPI | 1760231864 |
|---|---|
| Doing Business As | WIDE BEHAVIOR SERVICES LLC |
| Entity Type | Organization |
| Authorized Contact | JOSEPH SHUMBUSHO CEO 207-632-5106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 261Q00000X Clinic/Center | |
| 261QA0005X Clinic/Center, Ambulatory Family Planning Facility | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-05-13 |