NPIMap

Organization Active NPI

Katahdin Health Care LLC

  • Skilled Nursing Facility
  • Millinocket, ME
National Provider Identifier
1003149212
Registry record updated May 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
37158 Issued in ME
Legal business name
KATAHDIN HEALTH CARE LLC
Practice address
22 Walnut St
Millinocket, ME 04462-2128
Phone
(207) 723-4711
NPI assigned
Sep 8, 2009
Last updated
May 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ken Bowden
Title
Ceo
Phone
(207) 874-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 37158 ME Primary

Addresses

Primary practice location

22 Walnut St
Millinocket, ME 04462-2128

Mailing address

22 Walnut St
Millinocket, ME 04462-2128
Phone (207) 723-4711

Other identifiers 1

IdentifierTypeStateIssuer
435027000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090916000136 ME Part A Provider - Skilled Nursing Facility 5799831772 Practice locations: Millinocket, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003149212. Details of each certification follow.

Skilled nursing facility certification: CCN 205149

Legal name
KATAHDIN HEALTH CARE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1994
Last certification
Feb 12, 2025
Beds
36
Ownership / control type
Corporation
Multi-facility organization
First Atlantic Health Care
Organization structure
LLCProprietary
Enrollment address
22 Walnut St
Millinocket, ME 04462-2128
Nursing home name
KATAHDIN HEALTH CARE LLC
Affiliated entity
FIRST ATLANTIC HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Katahdin Health Care LLCCCN 205149 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3635.5 residents per day on average
Chain
First Atlantic Healthcare10 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

22 Walnut St
Millinocket, ME 04462
Phone (207) 723-4711

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christine Riendeau Individual Corporate OfficerVP Human Resources Oct 1, 2024 100%
Operational/Managerial Control Oct 1, 2024
Adp of the SNF Oct 1, 2024
Craig G Coffin Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2019 66.67%
Trustee of the SNF Oct 1, 2024
Adp of the SNF Jun 30, 2019
Eastern Maine Medical Center Organization, Brewer, ME Corporation 5% Or Greater Direct Ownership Interest Oct 1, 2018 50%
Kenneth W Bowden Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2019 33.33%
Adp of the SNF Jun 30, 2019
First Atlantic Healthcare Inc Organization, South Portland, ME Corporation, Chain home office Operational/Managerial Control Sep 1, 2009
Adp of the SNF Feb 23, 2025
Kimberly Bernard Individual Corporate OfficerCfo Oct 1, 2024 100%
Operational/Managerial Control Oct 1, 2024
Adp of the SNF Oct 1, 2024
Andrea Otis-Higgins Individual Corporate OfficerCoo May 11, 2015 100%
Operational/Managerial Control May 11, 2015
Adp of the SNF May 11, 2015
Alexandra Me Idenburg Individual Operational/Managerial Control Nov 1, 2021
Adp of the SNF Nov 1, 2021
Jennifer Brown Individual Operational/Managerial Control Sep 1, 2023
Adp of the SNF Sep 1, 2023
First Atlantic Corporation Organization, South Portland, ME Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2009 50%
Adp of the SNF Jun 30, 2019
Direct Ownership Interest Jun 30, 2019 50%
Wanda Pelkey Individual Corporate OfficerCeo Oct 1, 2024 100%
Operational/Managerial Control Oct 1, 2024
Adp of the SNF Oct 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273017600000",
    "number": "1003149212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WALNUT ST",
            "city": "MILLINOCKET",
            "state": "ME",
            "postal_code": "044622128",
            "telephone_number": "207-723-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 WALNUT ST",
            "city": "MILLINOCKET",
            "state": "ME",
            "postal_code": "044622128",
            "telephone_number": "207-723-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATAHDIN HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2010-05-05",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-874-2700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "37158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435027000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Millinocket, ME

Sources for this page

Verify at the official NPI Registry.