National Provider Identifier Database

LIBERTY BAY RECOVERY CENTER LLC
Rehabilitation, Substance Use Disorder


Contact Information

LIBERTY BAY RECOVERY CENTER, LLC
343 FOREST AVE
PORTLAND, ME04101-2006
Phone: 207-772-9800
Fax: 207-536-1511
Website:
Specialty Taxonomy Code
* Rehabilitation, Substance Use Disorder 261QR0405X
Substance Abuse Disorder Rehabilitation Facility 324500000X

* Indicates primary specialty

NPI Profile & details for LIBERTY BAY RECOVERY CENTER, LLC

NPI Number 1104212182
Legal business name
LBN
LIBERTY BAY RECOVERY CENTER, LLC
Authorized official BRUCE JARVIE - (VP, TREASURER)
Entity Organization
Organization subpart No
Enumeration date 04/07/2015
Last updated 09/04/2024 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • ME License #: 684958

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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