MR. RANDALL S ROBERTS (NPI# 1649404609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1649404609 |
Entity Type | Individual |
Full Name | MR. RANDALL S ROBERTS |
Practice Address |
52 Gardner Street Apt A Patten ME 04765 |
Mailing Address |
Po Box 226 Patten ME 04765-0226 |
Practice Telephone | 2075385279 |
Mailing Telephone | 2075385279 |
Enumeration Date | 2009-05-06 |
Last Update Date | 2009-05-06 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ME | 432861500 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033207535 | Randall Thomas Roberts | Chiropractor | 1240 E Highway 193, Suite G8, Layton, UT 84040-8544 | 2006-10-10 |
1114929809 | Randall F Roberts | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1019 S Central Ave, Glendale, CA 91204-2210 | 2005-08-11 |
Street Address |
52 GARDNER STREET APT A |
City | PATTEN |
State | ME |
Zip Code | 04765 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285043869 | Angela Anderson | Registered Nurse | 30 Houlton St., Patten, ME 04765 | 2014-08-07 |
1386878346 | Kimberly Iverne Rodriguez | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 52 Gardiner Street, Patten, ME 04765 | 2009-05-06 |
1528260783 | Town of Patten | Ambulance | 27 Dearborn St., Patten, ME 04765 | 2007-06-01 |
1700941333 | Green Valley Association | Day Training, Developmentally Disabled Services | 69 David St, Island Falls, ME 04765 | 2006-12-26 |
1518022151 | Green Valley Association | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13 Gardner Street, Patten, ME 04765 | 2006-12-26 |
1639230113 | Chandler Bay Group, Inc | Skilled Nursing Facility | 83 Houlton Road, Patten, ME 04765 | 2006-12-12 |
1811917545 | Denise M Marquis | Nurse's Aide | 30 Houlton Street, Patten, ME 04765 | 2006-07-19 |
1609824747 | Ronald I Blum | Specialist | 17 Founders Street, Patten, ME 04765 | 2006-05-04 |
1699770222 | Rose M Fuchs | Family Medicine | 17 Founders St, Patten, ME 04765 | 2005-06-20 |
1720648116 | Crystal Holly Pipes | Registered Nurse | 529 S Patten Rd, Patten, ME 04765 | 2019-06-18 |
Find all providers in zip 04765 |
Taxonomy Code | 320900000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386878346 | Kimberly Iverne Rodriguez | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 52 Gardiner Street, Patten, ME 04765 | 2009-05-06 |
1518022151 | Green Valley Association | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13 Gardner Street, Patten, ME 04765 | 2006-12-26 |
1437295359 | Green Valley Association | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13 Gardner Street, Patten, ME 04765 | 2007-01-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710585591 | Assurance Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10 Gracelawn Rd Apt 3, Auburn, ME 04210-6557 | 2020-10-13 |
1033722236 | Maine Shared Living | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 715 Upper St, Turner, ME 04282-3808 | 2020-08-26 |
1730797465 | Dirigo Support Professionals LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 176 Broad St Apt 1, Auburn, ME 04210-5610 | 2020-07-20 |
1154948206 | Quality Care Access, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 22 Wayne St, Portland, ME 04102-2228 | 2020-07-05 |
1558987438 | Moonlight Group Homes LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 253 Lisbon Street, Lewiston, ME 04240-7704 | 2020-06-17 |
1629617477 | Compass Bridges LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 14 Arrowhead Dr, Brunswick, ME 04011-7420 | 2019-12-26 |
1538705637 | Grace Support Services, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 86 Euclid Ave, Portland, ME 04103-1240 | 2019-11-23 |
1467097709 | Pine Peak Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1395 Congress St, Portland, ME 04102-2120 | 2019-11-11 |
1306480108 | Pine Peak Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13 Sara Ln, Portland, ME 04103-3622 | 2019-11-05 |
1821648650 | Advanced Care Solutions LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 88 Knox St, Lewiston, ME 04240-7406 | 2019-09-13 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.