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Organization Active NPI

Ross Manor Associates

Doing business as Ross Manor

  • Skilled Nursing Facility
  • Bangor, ME
National Provider Identifier
1962499053
Registry record updated May 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2099 Issued in ME
Legal business name
ROSS MANOR ASSOCIATES
Doing business as
Ross Manor
Practice address
758 Broadway
Bangor, ME 04401-3224
Phone
(207) 874-2700
NPI assigned
Oct 4, 2005
Last updated
May 19, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2009

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

Authorized official

Name
Kenneth Bowden
Title
Ceo
Phone
(207) 874-2700

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 1988 ME
Occupational Medicine Clinic/Center 261QX0100X 1988 ME
Skilled Nursing Facility 314000000X 2099 ME Primary
Speech-Language Pathologist 235Z00000X 1988 ME

Addresses

Primary practice location

758 Broadway
Bangor, ME 04401-3224

Mailing address

758 Broadway
Bangor, ME 04401-3224
Phone (207) 874-2700

Other identifiers 2

IdentifierTypeStateIssuer
120640000MedicaidME
120640001MedicaidME

Other names 1

  • Ross Manor Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030905000003 ME Part A Provider - Skilled Nursing Facility 4486565744 Practice locations: Bangor, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962499053. Details of each certification follow.

Skilled nursing facility certification: CCN 205064

Legal name
ROSS MANOR ASSOCIATES
Doing business as
LTC LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 28, 1991
Last certification
Apr 17, 2025
Beds
103
Ownership / control type
Corporation
Multi-facility organization
First Atlantic Healthcare
Organization structure
PartnershipProprietary
Incorporated
Jul 14, 1987 in ME
Enrollment address
758 Broadway
Bangor, ME 04401-3224
Nursing home name
ROSS MANOR
Affiliated entity
FIRST ATLANTIC HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ross ManorCCN 205064 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 28, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10396.0 residents per day on average
Chain
First Atlantic Healthcare10 facilities in the chain
Penalties (3 years)
1Fines totaling $8,018

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Ross Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Craig G Coffin Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2019 66.67%
Trustee of the SNF Oct 1, 2024
Adp of the SNF Jun 30, 2019
Indirect Ownership Interest Jun 30, 2019 66.67%
Eastern Maine Medical Center Organization, Brewer, ME LLC 5% Or Greater Direct Ownership Interest Sep 25, 2018 50%
Adp of the SNF Sep 25, 2018
Kenneth W Bowden Individual 5% Or Greater Indirect Ownership Interest Jun 30, 2019 33.33%
Adp of the SNF Jun 30, 2019
Janet Edgecomb Individual Operational/Managerial Control Nov 1, 2024
Adp of the SNF Nov 1, 2024
First Atlantic Healthcare Inc Organization, South Portland, ME Corporation, Chain home office Operational/Managerial Control Jul 14, 1987
Adp of the SNF Feb 23, 2025
Fred Fridman Individual Operational/Managerial Control Nov 1, 2024
Adp of the SNF Jul 11, 2024
Andrea Otis-Higgins Individual Corporate OfficerCoo May 11, 2015 100%
Operational/Managerial Control May 11, 2015
Adp of the SNF May 11, 2015
Maine Medical Consultants PC Organization, Portland, ME Corporation, Medical provider/supplier Adp of the SNF Jul 11, 2024
First Atlantic Corporation Organization, South Portland, ME Corporation 5% Or Greater Direct Ownership Interest Jul 14, 1987 50%
Adp of the SNF Jul 14, 1987
Direct Ownership Interest Jul 14, 1987 50%
Wanda Pelkey Individual Corporate OfficerCeo Oct 1, 2024 100%
Operational/Managerial Control Oct 1, 2024
Adp of the SNF Oct 1, 2024

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242691200000",
    "number": "1962499053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013224",
            "telephone_number": "207-874-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013224",
            "telephone_number": "207-874-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSS MANOR ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2009-05-19",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-874-2700"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ME",
            "license": "1988",
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "ME",
            "license": "1988",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "2099",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ME",
            "license": "1988",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120640000",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120640001",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ross Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.