LIBERTY BAY RECOVERY CENTER LLC NPI 1104212182

NPI Information

NPI: 1104212182
Provider Name: LIBERTY BAY RECOVERY CENTER, LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 20D2111660

Address:
343 FOREST AVE
PORTLAND, ME
ZIP 04101
Phone: (207) 772-9800
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LIBERTY BAY RECOVERY CENTER, LLC is a rehabilitation and substance use disorder clinic center in Portland, ME. LIBERTY BAY RECOVERY CENTER, LLC NPI is 1104212182. The provider is registered as an organization entity type.

The provider's business location address is:

343 FOREST AVE
PORTLAND, ME
ZIP 04101-006
Phone: (207) 772-9800
Fax: (207) 536-1511

The provider's authorized official is Michael Saul .
The authorized official title is Vp and has the following contact phone number (214) 379-3300.

The CLIA number assigned to this NPI record is 20D2111660 - other - narcotic treat center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/7/2015 and was last updated on 2/13/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	684958	MAINE	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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