Northbridge Avita Wells II LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

NORTHBRIDGE AVITA WELLS II LLC

Doing business as

Avita of Wells

Practice address

86 Sanford Rd
Wells, ME 04090-5532

Phone

(207) 646-3444

Fax

(207) 646-5444

NPI assigned

Mar 1, 2019

Last updated

Mar 1, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

NORTHBRIDGE AVITA WELLS II LLCAs reported in NPPES

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

Authorized official

Name

Wendy Nowokunski

Title

President

Phone

(781) 238-4856

Specialties & licenses 1

Addresses

Other names 1

• Avita of Wells Doing business as

Part of

Northbridge Avita Wells II LLC

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

{
    "created_epoch": "1551398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551398400000",
    "number": "1417414152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 SANFORD RD",
            "city": "WELLS",
            "state": "ME",
            "postal_code": "040905532",
            "telephone_number": "207-646-3444",
            "fax_number": "207-646-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 SANFORD RD",
            "city": "WELLS",
            "state": "ME",
            "postal_code": "040905532",
            "telephone_number": "207-646-3444",
            "fax_number": "207-646-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHBRIDGE AVITA WELLS II LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHBRIDGE AVITA WELLS II LLC",
        "enumeration_date": "2019-03-01",
        "last_updated": "2019-03-01",
        "status": "A",
        "authorized_official_last_name": "NOWOKUNSKI",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-238-4856"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita of Wells",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Alzheimer Center (Dementia Center) in Wells, ME
• Providers in Wells, ME by specialty
• Alzheimer Center (Dementia Center) in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; 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.