Manor at Phillipstown Place Inc

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

ALLS 2770 Issued in ME

Legal business name

MANOR AT PHILLIPSTOWN PLACE INC

Practice address

164 Hanson Ridge Rd
Springvale, ME 04083-5403

Phone

(207) 324-3371

NPI assigned

Apr 28, 2009

Organization subpart

Yes

Parent organization

MANOR AT PHILLIPSTOWN PLACE INCAs reported in NPPES

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

Authorized official

Name

Mr. Ron Bryant

Title

Chief Financial Officer

Phone

(207) 490-7327

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mountain View Other name

Tax ID family

Manor at Phillipstown Place Inc2 organizations share this tax ID, including this one

Part of

Manor at Phillipstown Place Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Manor at Phillipstown Place Inc

  • Assisted Living Facility
  • Sanford, ME
  • NPI 1104060656
  NPD tax ID

Locations

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240876800000",
    "number": "1295979755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JUNE ST",
            "city": "SANFORD",
            "state": "ME",
            "postal_code": "040732621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 HANSON RIDGE RD",
            "city": "SPRINGVALE",
            "state": "ME",
            "postal_code": "040835403",
            "telephone_number": "207-324-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR AT PHILLIPSTOWN PLACE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MANOR AT PHILLIPSTOWN PLACE INC",
        "enumeration_date": "2009-04-28",
        "last_updated": "2009-04-28",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "207-490-7327",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "ME",
            "license": "ALLS 2770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124600000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain View",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Molly Lobel, NP
• Ashleigh E. Locklear, LCSW
• Lindsey Lokken
• Carol Lombard, LSW
• Susanne Taylor Mallon, M.A.
• Amy Louise Marcotte, LCSW
• Cindy Jean Mathieson, LCPC
• Christine Elizabeth McAuley, M.S. CCC-SLP
• Kathleen Garvey McDonough, LCSW
• Colleen McDougal, LSW

• All providers in Springvale, ME
• Custodial Care Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; 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.