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General NPI Number Information
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NPI Number | 1639230113
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Entity Type | Organization
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Legal Business Name | CHANDLER BAY GROUP, INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 83 HOULTON ROAD
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City | PATTEN
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State | ME
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Zip | 04765
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Country | US
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Telephone | 207-528-2200
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Fax | 207-528-6265
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Provider Business Mailing Address
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Address Line | 179 LISBON ST 2ND FLOOR
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City | LEWISTON
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State | ME
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Zip | 04240-7248
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Country | US
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Telephone | 207-786-3554
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Fax | 207-786-8507
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MR. GLEN G CYR
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Credential |
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Telephone | 207-786-3554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 36427
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License Number State | ME
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