Nancy J. Mitchell Home Trust

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

126500000 Issued in ME

Legal business name

NANCY J. MITCHELL HOME TRUST

Practice address

1 Sandy Beach Lane
Indian Island, ME 04468

Phone

(207) 827-6688

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Carl G Mitchell

Title

Trustee

Phone

(207) 827-6688

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1891832382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1381",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SANDY BEACH LANE",
            "city": "INDIAN ISLAND",
            "state": "ME",
            "postal_code": "04468",
            "telephone_number": "207-827-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANCY J. MITCHELL HOME TRUST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "TRUSTEE",
        "authorized_official_telephone_number": "207-827-6688",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "ME",
            "license": "126500000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53161131A",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea J. Mietkiewicz, RN
• Tanya M Miller, RN
• Kristi Mitchell, RN
• Marie Mitchell, LCPC, CADC
• Nitisha Lyne Mitchell
• Claud Neptune, LCSW
• Winona Alice Nicolar
• Noli Trpinawzk Corp
• Leslie Maxwell Ohmart III, RPH
• Penobscot Indian Nation

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Indian Island, ME
• Providers in Indian Island, ME by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.