Active NPI
Elr Care Maine LLC
Doing business as Northern Bay Residential Care
- Assisted Living Facility
- Penobscot, ME
National Provider Identifier
1760626246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 2335
- Legal business name
- ELR CARE MAINE LLC
- Doing business as
- Northern Bay Residential Care
- Practice address
- 12 North Penobscot Road
Penobscot, ME 04476 - Phone
- (207) 326-4344
- Fax
- (207) 326-9615
- NPI assigned
- Apr 28, 2009
- Last updated
- Aug 3, 2010
- Organization subpart
- Yes
- Parent organization
- ELR CARE MAINE LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Michael Tyler
- Title
- Receiver
- Phone
- (207) 854-2973
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 2335 | ME | Primary |
Addresses
Primary practice location
12 North Penobscot Road
Penobscot, ME 04476
Mailing address
12 North Penobscot Road
Penobscot, ME 04476
Phone (207) 326-4344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 405380005 | Medicaid | ME |
Other names 1
- Northern Bay Residential Care
National Provider Directory
National Provider Directory- Part of
- Elrcare Maine LLC
Practitioners & affiliated clinicians
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.
-
- Speech-Language Pathologist
- Penobscot, ME
- NPI 1891117131
-
- Physical Therapist
- Penobscot, ME
- NPI 1467723254
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240876800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1280793600000",
"number": "1760626246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 NORTH PENOBSCOT ROAD",
"city": "PENOBSCOT",
"state": "ME",
"postal_code": "04476",
"telephone_number": "207-326-4344",
"fax_number": "207-326-9615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 NORTH PENOBSCOT ROAD",
"city": "PENOBSCOT",
"state": "ME",
"postal_code": "04476",
"telephone_number": "207-326-4344",
"fax_number": "207-326-9615"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELR CARE MAINE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ELR CARE MAINE LLC",
"enumeration_date": "2009-04-28",
"last_updated": "2010-08-03",
"status": "A",
"authorized_official_last_name": "TYLER",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "RECEIVER",
"authorized_official_telephone_number": "207-854-2973",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "ME",
"license": "2335",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "405380005",
"state": "ME"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Northern Bay Residential Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Penobscot, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.