Avita Wells LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

AVITA WELLS LLC

Doing business as

Avita of Wells

Practice address

86 Sanford Road
Wells, ME 04090

Phone

(207) 646-3444

Fax

(207) 646-5444

NPI assigned

Dec 13, 2016

Last updated

Dec 13, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

NORTHBRIDGE COMPANIESAs reported in NPPES

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

Authorized official

Name

Courtney Freeman

Title

Senior Executive Director

Phone

(207) 844-0956

Specialties & licenses 1

Addresses

Other names 1

• Avita of Wells Doing business as

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1891239679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 SANFORD ROAD",
            "city": "WELLS",
            "state": "ME",
            "postal_code": "04090",
            "telephone_number": "207-646-3444",
            "fax_number": "207-646-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 SANFORD ROAD",
            "city": "WELLS",
            "state": "ME",
            "postal_code": "04090",
            "telephone_number": "207-646-3444",
            "fax_number": "207-646-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA WELLS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHBRIDGE COMPANIES",
        "enumeration_date": "2016-12-13",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "SENIOR EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "207-844-0956"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita of Wells",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jane G. Adams, APRN-BC
• Rosemary Ananis, MSW
• Elizabeth Marie Anderson, P.T.
• Bethanny Araujo
• Atlantic Pines Oral Surgery and Anesthesia
• Catherine W. Bartok, MS, LCPC
• James Brian Berube, PT
• Kayla E Billings, MS, OTR/L
• Blue Swan Psychiatry, PLLC
• Lawrence Andrew Boyle, DDS

• Alzheimer Center (Dementia Center) in Wells, ME
• Providers in Wells, 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 Dec 13, 2016; 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.