Avita Stroudwater, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

AVITA STROUDWATER, LLC

Doing business as

Avita of Stroudwater

Practice address

320 Spring Street
Westbrook, ME 04092

Phone

(207) 857-9007

Fax

(207) 857-9017

NPI assigned

Sep 3, 2013

Last updated

Sep 3, 2013By 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. Shawn Bertram

Title

Vice President of Operations

Phone

(781) 272-2424

Specialties & licenses 1

Addresses

Other names 1

• Avita of Stroudwater Doing business as

Locations

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1760816276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 3RD AVE",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018034430",
            "telephone_number": "781-272-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 SPRING STREET",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "04092",
            "telephone_number": "207-857-9007",
            "fax_number": "207-857-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA STROUDWATER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "BERTRAM",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "781-272-2424",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita of Stroudwater",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy Ashbaugh
• Ronald W Ashkenasy, D.O..
• Emily Ashley, LCPC-CC
• Katelyn Marie Austin, DPT
• Samantha Averill
• Scott D Ayre, P.T.
• Azel Residential Care LLC
• Karen Louise Backman, L.C.P.C.
• Elizabeth Bacon, LCSW, CADC
• Alicia Ellen Bailey, MOTR/L

• Alzheimer Center (Dementia Center) in Westbrook, ME
• Providers in Westbrook, ME by specialty
• Alzheimer Center (Dementia Center) in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.