Provider Demographics
NPI:1780827881
Name:GREAT BAY SERVICES
Entity Type:Organization
Organization Name:GREAT BAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOWY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-842-5344
Mailing Address - Street 1:23 CATARACT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3908
Mailing Address - Country:US
Mailing Address - Phone:603-842-5344
Mailing Address - Fax:603-343-4465
Practice Address - Street 1:61 WASHINGTON ST STE 4
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3093
Practice Address - Country:US
Practice Address - Phone:207-850-1053
Practice Address - Fax:207-850-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2023-06-06
Deactivation Date:2020-06-10
Deactivation Code:
Reactivation Date:2023-04-28
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X, 253Z00000X, 261QD1600X, 315P00000X
MEALLS2515320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME138420000OtherMAINECARE