Provider Demographics
NPI:1639230113
Name:CHANDLER BAY GROUP, INC
Entity Type:Organization
Organization Name:CHANDLER BAY GROUP, INC
Other - Org Name:MT HEIGHTS HEALTHCARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-786-3554
Mailing Address - Street 1:179 LISBON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7248
Mailing Address - Country:US
Mailing Address - Phone:207-786-3554
Mailing Address - Fax:207-786-8507
Practice Address - Street 1:83 HOULTON ROAD
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765
Practice Address - Country:US
Practice Address - Phone:207-528-2200
Practice Address - Fax:207-528-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36427314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205181Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER