Active NPI
Fallbrook Care Operations, LLC
- Skilled Nursing Facility
- Portland, ME
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- FALLBROOK CARE OPERATIONS, LLC
- Practice address
- 91 Merrymeeting Dr
Portland, ME 04103-3959 - Phone
- (207) 786-3554
- NPI assigned
- Apr 29, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Glen Cyr
- Title
- Senior Vice President of Finance
- Phone
- (207) 786-3554
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
91 Merrymeeting Dr
Portland, ME 04103-3959
Mailing address
PO Box 1408
Lewiston, ME 04243-1408
Phone (207) 786-3554
Other names 1
- Fallbrook Commons
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240905004418 | ME | Part A Provider - Skilled Nursing Facility | 0244770139 | Practice locations: Portland, ME |
Skilled nursing facility certification: CCN 205134
- Legal name
- FALLBROOK CARE OPERATIONS, LLC
- Doing business as
- FALLBROOK COMMONS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1993
- Last certification
- Aug 22, 2024
- Beds
- 102
- Ownership / control type
- Other Nonprofit
- Most recent change of ownership
- Sep 13, 2024
- Organization structure
- LLC
- Enrollment address
- 91 Merrymeeting Dr
Portland, ME 04103-3959 - Nursing home name
- FALLBROOK COMMONS
- Affiliated entity
- NORTH COUNTRY ASSOCIATES
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Fallbrook Commons
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Other
- Certified
- Jan 1, 1993
- Medicare certification status
- Active
- Certified beds
- 102
- Chain
- North Country Associates
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 20D0088668 | Fallbrook Commons | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
91 Merrymeeting Dr
Portland, ME 04103
Phone (207) 331-9292
Ownership & related parties
All disclosed owners & managing parties 30
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel Maguire | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 10% |
| Adp of the SNF | Dec 30, 2024 | ||
| Fallbrook Care Operations, LLC | Operational/Managerial Control | Dec 2, 2024 | |
| Adp of the SNF | Dec 2, 2024 | ||
| Joel Rogers | Operational/Managerial Control | Oct 31, 2024 | |
| Adp of the SNF | Dec 30, 2024 | ||
| Glen G Cyr | Operational/Managerial Control | Oct 31, 2024 | |
| Adp of the SNF | Dec 2, 2024 | ||
| Laundry French Construction Company LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 8.3% |
| Adp of the SNF | Sep 13, 2024 | ||
| Michael C Tyler | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 10% |
| Adp of the SNF | Oct 31, 2024 | ||
| Paul Harstad | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 4.43% |
| Richard T Marino | Operational/Managerial Control | Dec 30, 2024 | |
| Adp of the SNF | Dec 30, 2024 | ||
| DLF-MCT Equity Partners, LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 0.28% |
| Mary Jane Richards | Operational/Managerial Control | Oct 31, 2024 | |
| Indirect Ownership Interest | Sep 13, 2024 | 2.77% | |
| WR Realty LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 11.07% |
| WR Realty | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 11.07% |
| Adp of the SNF | Sep 13, 2024 | ||
| Indirect Ownership Interest | Sep 13, 2024 | 1.66% | |
| John C Orestis | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 50% |
| Adp of the SNF | Dec 2, 2024 | ||
| Denis Landry | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 5.54% |
| David Friedman | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 30% |
| Adp of the SNF | Dec 30, 2024 | ||
| Stroudwater Sr Partners LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 5.81% |
| Indirect Ownership Interest | Sep 13, 2024 | 1.11% | |
| SPDB LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 0.89% |
| Botein & Company | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 2.77% |
| Indirect Ownership Interest | Sep 13, 2024 | 1.11% | |
| Poncher Investment Partners | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 3.88% |
| North South | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 2.77% |
| Knight Investment Company LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 2.21% |
| Indirect Ownership Interest | Sep 13, 2024 | 2.21% | |
| FB Portland LLC | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 5.54% |
| Adp of the SNF | Sep 13, 2024 | ||
| Indirect Ownership Interest | Sep 13, 2024 | 0.55% | |
| Great River Productions Profit Sharing Plan | 5% Or Greater Indirect Ownership Interest | Sep 13, 2024 | 1.66% |
| Indirect Ownership Interest | Sep 13, 2024 | 4.43% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Geriatric Medicine (Family Medicine) Physician
- Portland, ME
- NPI 1285665828
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Geriatric Medicine (Family Medicine) Physician
- Portland, ME
- NPI 1285665828
-
- Internal Medicine Physician
- Portland, ME
- NPI 1548654544
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Portland, ME
- NPI 1548654544
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714348800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1714348800000",
"number": "1649026832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1408",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042431408",
"telephone_number": "207-786-3554",
"fax_number": "207-786-8507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 MERRYMEETING DR",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041033959",
"telephone_number": "207-786-3554"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FALLBROOK CARE OPERATIONS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-04-29",
"last_updated": "2024-04-29",
"certification_date": "2024-04-28",
"status": "A",
"authorized_official_last_name": "CYR",
"authorized_official_first_name": "GLEN",
"authorized_official_title_or_position": "SENIOR VICE PRESIDENT OF FINANCE",
"authorized_official_telephone_number": "207-786-3554",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fallbrook Commons",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; 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.