Provider Demographics
NPI:1447672001
Name:BEYOND ACHIEVING SKILLS, LLC
Entity type:Organization
Organization Name:BEYOND ACHIEVING SKILLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMEBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CAOUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-615-2379
Mailing Address - Street 1:24 ANDERSON RD.
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071
Mailing Address - Country:US
Mailing Address - Phone:207-615-2379
Mailing Address - Fax:207-655-6105
Practice Address - Street 1:24 ANDERSON RD.
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071
Practice Address - Country:US
Practice Address - Phone:207-615-2379
Practice Address - Fax:207-655-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT575261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1184941163Medicaid