The Maine Fitness Store, Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

THE MAINE FITNESS STORE, INC

Practice address

849 Stillwater Ave
Suite 1
Bangor, ME 04401-3624

Phone

(207) 990-4552

Fax

(207) 990-4552

NPI assigned

Oct 18, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey N Leach

Title

President

Phone

(207) 990-4552

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Maine Fitness Doing business as

Locations

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

{
    "created_epoch": "1224288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224288000000",
    "number": "1225280597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 STILLWATER AVE",
            "address_2": "SUITE 1",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013624",
            "telephone_number": "207-990-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "849 STILLWATER AVE",
            "address_2": "SUITE 1",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013624",
            "telephone_number": "207-990-4552",
            "fax_number": "207-990-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MAINE FITNESS STORE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-18",
        "last_updated": "2008-10-18",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-990-4552",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEMIC",
            "identifier": "03103032",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maine Fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• In Home Supportive Care Agency in Bangor, ME
• Providers in Bangor, ME by specialty
• In Home Supportive Care Agency in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.