Bangor Nursing & Rehabilitation Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

36315 Issued in ME

Legal business name

BANGOR NURSING & REHABILITATION CENTER

Practice address

103 Texas Ave
Bangor, ME 04401-4324

Phone

(207) 947-4557

NPI assigned

Oct 19, 2005

Organization subpart

No

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

Authorized official

Name

Brian Donahue

Title

Cfo

Phone

(207) 947-4557

Specialties & licenses 1

Addresses

Other names 1

• Bangor Nursing and Rehabilitation Center Former legal business name

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Skilled nursing facility certification: CCN 205020A

Legal name

BANGOR NURSING & REHABILITATION CENTER

Doing business as

BANGOR NURSING & REHABILITATION CEN

Organization structure

CorporationNon-profit

Incorporated

Jan 1, 2001 in ME

Enrollment address

103 Texas Ave
Bangor, ME 04401-4324

Nursing home name

BANGOR NURSING & REHABILITATION CENTER

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

CLIA laboratory certificates

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 1

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

• Garrett R Martin, MD

  • Orthopaedic Surgery Physician
  • Bangor, ME
  • NPI 1669476438

  Corporate Director

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Garrett R Martin, MD

  • Orthopaedic Surgery Physician
  • Bangor, ME
  • NPI 1669476438
  NPD (past)
• Laura L Matones, DO

  • Internal Medicine Physician
  • Bangor, ME
  • NPI 1760450829
  NPD (past)
• Melinda S McInnis, FNPC

  • Family Nurse Practitioner
  • Bangor, ME
  • NPI 1699864504
  NPD (past)

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513814400000",
    "number": "1366431694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 TEXAS AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 TEXAS AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014324",
            "telephone_number": "207-947-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANGOR NURSING & REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2017-12-21",
        "status": "A",
        "authorized_official_last_name": "DONAHUE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "207-947-4557"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "36315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bangor Nursing and Rehabilitation Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Bangor Family Counseling Inc
• Bangor Family Dentistry
• Bangor Family Health Care
• Bangor Healthcare
• Bangor Mall Eye Association
• Bangor Plastic and Hand Surgery, P.a.
• Bangor Psychiatric Associates, PA
• Bangor Surgical Associates, P.a.
• Emily Banks, DPT
• Elizabeth Ann Baratta, MD

• All providers in Bangor, ME
• Skilled Nursing Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.