NPIMap

Organization Active NPI

Liberty Bay Recovery Center, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Portland, ME
National Provider Identifier
1104212182
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
684958 Issued in ME
Legal business name
LIBERTY BAY RECOVERY CENTER, LLC
Practice address
343 Forest Ave
Portland, ME 04101-2006
Phone
(207) 772-9800
Fax
(207) 536-1511
NPI assigned
Apr 7, 2015
Last updated
Sep 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 684958 ME Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

343 Forest Ave
Portland, ME 04101-2006

Mailing address

343 Forest Ave
Portland, ME 04101-2006
Phone (207) 772-9800

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D2111660Liberty Bay Recovery Center, LLC343 Forest Avenue, Portland, ME 04101Certificate of waiverApr 11, 2028

National Provider Directory

National Provider Directory

Locations

835 Forest Ave
Portland, ME 04103

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1104212182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 FOREST AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012006",
            "telephone_number": "207-772-9800",
            "fax_number": "207-536-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 FOREST AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012006",
            "telephone_number": "207-772-9800",
            "fax_number": "207-536-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY BAY RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "ME",
            "license": "684958",
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.