Healthcare Provider Details

I. General information

NPI: 1639230113
Provider Name (Legal Business Name): CHANDLER BAY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HOULTON ROAD
PATTEN ME
04765
US

IV. Provider business mailing address

179 LISBON ST 2ND FLOOR
LEWISTON ME
04240-7248
US

V. Phone/Fax

Practice location:
  • Phone: 207-528-2200
  • Fax: 207-528-6265
Mailing address:
  • Phone: 207-786-3554
  • Fax: 207-786-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number36427
License Number StateME

VIII. Authorized Official

Name: MR. GLEN G CYR
Title or Position: VP OF FINANCE
Credential:
Phone: 207-786-3554