Healthcare Provider Details

I. General information

NPI: 1538094263
Provider Name (Legal Business Name): B&B RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SWETTS POND RD
ORRINGTON ME
04474-3709
US

IV. Provider business mailing address

30 SWETTS POND RD
ORRINGTON ME
04474-3709
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-3399
  • Fax:
Mailing address:
  • Phone: 207-200-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EVAN ETTINGER
Title or Position: OWNER
Credential:
Phone: 207-200-3399