Wyatt Residential Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

WYATT RESIDENTIAL SERVICES LLC

Practice address

78 Foxcroft Dr
Scarborough, ME 04074-8734

Phone

(207) 409-0334

NPI assigned

Jun 9, 2025

Organization subpart

No

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

Authorized official

Name

Axel Nimbona

Title

Ceo

Phone

(207) 409-0334

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1346134871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 FOXCROFT DR",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040748734",
            "telephone_number": "207-409-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 FOXCROFT DR",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040748734",
            "telephone_number": "207-409-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYATT RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-08",
        "status": "A",
        "authorized_official_last_name": "NIMBONA",
        "authorized_official_first_name": "AXEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-409-0334"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Lea Winling, OTR/L
• Casey Lynn Winters, DC
• Marny E Witas, PHYSICAL THERAPIST
• Benjamin David Wood, DO
• Tasha Ann Worster, M.D.
• Elizabeth M Wyrick, PT
• Stephanie Ann Zaidlicz Goss, LMSW
• Janet Alleyne Zalanskas, APRN-BC
• Steven Zarembka, ND
• Heather Zietz, L.M.T.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Scarborough, ME
• Providers in Scarborough, ME by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.