MEDICARE: PRIORITY RESIDENTIAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1255202693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY RESIDENTIAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	220 PAYNE RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9568
Country	:	US
Telephone Number	:	207-831-7021
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 PAYNE RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9568
Country	:	US
Telephone Number	:	207-831-7021
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GLADYS M IRAKOZE
Credential	:
Telephone Number	:	207-831-7021

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	01/12/2026

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