Freeport Nursing Home, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

36218 Issued in ME

Legal business name

FREEPORT NURSING HOME, INC

Practice address

3 East St
Freeport, ME 04032-1405

Phone

(207) 786-0111

Fax

(207) 783-5016

NPI assigned

Aug 3, 2005

Organization subpart

No

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

Authorized official

Name

Mr. David R Hicks

Title

Owner

Phone

(207) 786-0111

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1477554111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 SUMMER ST",
            "city": "AUBURN",
            "state": "ME",
            "postal_code": "042105125",
            "telephone_number": "207-786-0111",
            "fax_number": "207-783-5016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 EAST ST",
            "city": "FREEPORT",
            "state": "ME",
            "postal_code": "040321405",
            "telephone_number": "207-786-0111",
            "fax_number": "207-783-5016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEPORT NURSING HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-786-0111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "36218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104840000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; 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.