ST JUDE'S FOSTER HOME (NPI# 1114168945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114168945 |
| Entity Type | Organization |
| Organization Name | ST JUDE'S FOSTER HOME |
| Other Organization Name | JUDY GAGNON |
| Practice Address |
123 Wright Street Von Buren ME 04785 |
| Practice Telephone | 2078685180 |
| Practice Fax Number | 2078687781 |
| Mailing Telephone | 2078685180 |
| Mailing Fax Number | 2078687781 |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-03-06 |
| Authorized Official Name | MRS. JUDY D GAGNON (FOSTER HOME OPERATOR) |
| Authorized Official Telephone | 2078685180 |
| Is Organization Subpart | N |
| 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 | 197470000 | 05 |
| Other Name | Type Code |
|---|---|
| Judy Gagnon | Other Name - Individual/Organization |
| Street Address |
123 WRIGHT STREET |
| City | VON BUREN |
| State | ME |
| Zip Code | 04785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679944490 | Kristin Theriault | Social Worker | 358 Hamlin Rd, Hamlin, ME 04785 | 2015-10-20 |
| 1508188517 | Myles Peter Ouellette | Massage Therapist | 204 Champlain St, Van Buren, ME 04785 | 2010-02-17 |
| 1336380443 | Ouellette Foster Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 162 State Street, Van Buren, ME 04785 | 2009-03-19 |
| 1184852022 | Bernadette Fortin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 144 High St, Van Buren, ME 04785 | 2009-06-30 |
| 1245754209 | Walgreen Co | Pharmacy | 21 Main St, Van Buren, ME 04785-1008 | 2017-08-01 |
| 1760761134 | Katie Daigle | Pharmacist | 21 Main St, Van Buren, ME 04785-1008 | 2011-08-16 |
| 1174814396 | Marion Brett Felty | Pharmacist | 21 Main St, Van Buren, ME 04785-1008 | 2011-04-21 |
| 1851462931 | Rite Aid of Maine Inc | Durable Medical Equipment & Medical Supplies | 21 Main Street, Van Buren, ME 04785-1008 | 2006-11-13 |
| 1366051666 | Lindsey Desrosier | Nurse Practitioner | 4 Main St, Van Buren, ME 04785-1009 | 2020-07-23 |
| 1003356809 | Allison Guerrette | Registered Nurse | 4 Main St, Van Buren, ME 04785-1009 | 2017-02-28 |
| Find all providers in zip 04785 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| Find all providers with the same taxonomy | ||||
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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.