Avita Brunswick LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

AVITA BRUNSWICK LLC

Practice address

89 Admiral Fitch Way
Brunswick, ME 04011

Phone

(207) 729-6222

NPI assigned

Dec 13, 2016

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 Brunswick 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": "1992249775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 ADMIRAL FITCH WAY",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "04011",
            "telephone_number": "207-729-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 ADMIRAL FITCH WAY",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "04011",
            "telephone_number": "207-729-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVITA BRUNSWICK 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 Brunswick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas J. Augat, D.C.
• Aurelia Counseling LLC
• Abby Kathryn Austin, FNP
• Kristen Beth Austin, RPH
• Stephen Austin, M.D.
• Gabrielle Rose Babai, PSY.D.
• Charles Babineau
• Darcy M Baggett, LCSW
• Robin Baier
• Elizabeth L Bailey, LCSW

• Alzheimer Center (Dementia Center) in Brunswick, ME
• Providers in Brunswick, 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.