Provider Demographics
NPI:1053545426
Name:BECKET ACADEMY, INC.
Entity type:Organization
Organization Name:BECKET ACADEMY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-353-9102
Mailing Address - Street 1:633 NH ROUTE #10
Mailing Address - Street 2:P.O. BOX 325
Mailing Address - City:ORFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03777
Mailing Address - Country:US
Mailing Address - Phone:603-353-9102
Mailing Address - Fax:603-353-9412
Practice Address - Street 1:746 OAKLAND ROAD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917
Practice Address - Country:US
Practice Address - Phone:207-634-2590
Practice Address - Fax:207-634-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432466200Medicaid