WYATT RESIDENTIAL SERVICES LLC NPI 1346134871

NPI Information

  • NPI: 1346134871
  • Provider Name: WYATT RESIDENTIAL SERVICES LLC
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Organization
  • Address: 78 FOXCROFT DR
    SCARBOROUGH, ME
    ZIP 04074
  • Phone: (207) 409-0334

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NPI Details

WYATT RESIDENTIAL SERVICES LLC is a community based residential treatment facility, intellectual and/or developmental disabilities in Scarborough, ME. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. WYATT RESIDENTIAL SERVICES LLC NPI is 1346134871. The provider is registered as an organization entity type.

The provider's business location address is:

78 FOXCROFT DR
SCARBOROUGH, ME
ZIP 04074-734
Phone: (207) 409-0334

The provider's authorized official is Axel Nimbona .
The authorized official title is Ceo and has the following contact phone number (207) 409-0334.

The enumeration date for this NPI number is 6/9/2025 and was last updated on 6/9/2025.

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
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

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: 11/21/2025

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