Seventy Five State Street

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALLS2085 Issued in ME

Legal business name

SEVENTY FIVE STATE STREET

Practice address

75 State St
Portland, ME 04101-3746

Phone

(207) 772-2675

Fax

(207) 772-2896

NPI assigned

Apr 17, 2009

Last updated

Oct 1, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Anthony Forgione

Title

President/Ceo

Phone

(207) 772-2675

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan D. Paul, MD

  • Internal Medicine Physician
  • Bridgton, ME
  • NPI 1316102478
  NPD (past)
• Michael Vancleef Delahunt, MD

  • Internal Medicine Physician
  • Sanbornville, NH
  • NPI 1245274703
  NPD (past)

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1528201738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 STATE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013746",
            "telephone_number": "207-772-2675",
            "fax_number": "207-772-2896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 STATE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013746",
            "telephone_number": "207-772-2675",
            "fax_number": "207-772-2896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEVENTY FIVE STATE STREET",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "FORGIONE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "207-772-2675",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ME",
            "license": "ALLS2085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101970000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louis Sepulveda
• Serenity House, Inc.
• Elizabeth G Serrage, M.D.
• Raymond Serrano, M.D.
• Services Aid Home Care LLC
• Theresa Seward, MS, LCPC
• Bronwyn Elizabeth Sewell, NP
• Richard Devillers Seymour, ED. D
• SGR, Inc.
• Kassandra M Shackley

• Assisted Living Facility in Portland, ME
• Providers in Portland, ME by specialty
• Assisted Living Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; 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.