200 Years Old, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

200 YEARS OLD, LLC

Practice address

5 Blackstrap Rd
Falmouth, ME 04105-2223

Phone

(207) 518-0881

NPI assigned

Dec 6, 2021

Organization subpart

No

Name

Mr. Maurice Habimfura

Title

Registered Nurse

Phone

(207) 518-0881

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 7, 2023.

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673049600000",
    "number": "1508524638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BLACKSTRAP RD",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041052223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 BLACKSTRAP RD",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041052223",
            "telephone_number": "207-518-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "200 YEARS OLD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2023-01-07",
        "certification_date": "2023-01-07",
        "status": "A",
        "authorized_official_last_name": "HABIMFURA",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "207-518-0881",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "endpointDescription": "N/A",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "N/A",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "End-point-will-be-used",
            "address_1": "5 Blackstrap Rd",
            "city": "Falmouth",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041052223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2023; 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.