Medical Care Management, Inc
Organization Active NPI Skilled Nursing Facility · Lewiston, ME
NPI 1962562272 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1962562272
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2065 (ME)
- Legal business name
- MEDICAL CARE MANAGEMENT, INC
- Practice address
- 179 Lisbon St
2ND Floor
Lewiston, ME 04240-7248 - Phone
- (207) 786-3554
- Fax
- (207) 786-8507
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Glen G Cyr
- Title
- VP of Finance
- Phone
- (207) 786-3554
Practitioners 3
-
Deana L Albert, N.P.
-
Thomas C Hattan, MD
-
Tina Louise Love, FNP-C
Affiliated clinicians 3
-
Deana L Albert, N.P.
-
Thomas C Hattan, MD
-
Tina Louise Love, FNP-C
Medicare Care Compare: Nursing home
- Listed as
- Russell Park Rehabilitation & Living Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Aug 19, 1981
- Medicare certification status
- Active
- Certified beds
- 50 · 42.9 residents per day on average
- Chain
- North Country Associates
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 20D0877494 | Russell Park Rehab and Living Center | Certificate of waiver | Oct 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Skilled nursing facility certification: CCN 205052
- Legal name
- MEDICAL CARE MANAGEMENT, INC
- Doing business as
- RUSSELLL PARK REHAB AND LIVING CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 19, 1981
- Last certification
- Mar 14, 2024
- Beds
- 50
- Ownership / control type
- Corporation
- Multi-facility organization
- North Country Assoiciates
- Organization structure
- Corporation · Proprietary
- Incorporated
- Dec 30, 2000 in ME
- Enrollment address
- 158 Russell St
Lewiston, ME 04240-6027 - Nursing home name
- RUSSELL PARK REHABILITATION & LIVING CENTER
- Affiliated entity
- NORTH COUNTRY ASSOCIATES
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Glen G Cyr |
Corporate Director |
Jan 1, 2008 | 40% |
| W-2 Managing Employee |
Jan 1, 2008 | 40% | |
| John C Orestis |
5% Or Greater Direct Ownership Interest |
Jan 1, 1986 | 100% |
| Corporate Officer |
Jan 1, 1986 | 100% | |
| W-2 Managing Employee |
Jan 1, 1986 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061212000509 | ME | Part a Provider - Skilled Nursing Facility | 9638178007 | Practice locations: Lewiston, ME |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2065 | ME | Yes |
Addresses
Primary practice location
179 Lisbon St
2ND Floor
Lewiston, ME 04240-7248
Mailing address
158 Russell St
Lewiston, ME 04240-6027
Phone (207) 786-0691
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 024138 | Other | ME | BCBS PROVIDER # |
Other names
- Russell Park Manor
Other providers in Lewiston, ME
- Kemedy McQuillen
- Michael McRae
- Jean McWilliams
- Danielle Meader
- Medcare LLC
- Medical Rehabilitation Associates
- Nia Megquier
- Stephanie Mellen
- James Melloh
- Sarah A Meltzer
All providers in Lewiston, ME · Skilled Nursing Facility in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.