Basic Information
| Provider Information | |||||||||
| NPI: | 1720214950 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JMPB INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ASSISTANCE PLUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 358 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049370358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074534708 | ||||||||
| FaxNumber: | 2074536250 | ||||||||
| Practice Location | |||||||||
| Address1: | 1604 BENTON AVE | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049013327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074534708 | ||||||||
| FaxNumber: | 2074536250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 06/29/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOWEN | ||||||||
| AuthorizedOfficialFirstName: | JOHNNA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2074534708 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | 02971 | ME | N | Agencies | In Home Supportive Care | 251B00000X | 406317 | ME | N | Agencies | Case Management | 251C00000X | 406317 | ME | N | Agencies | Day Training, Developmentally Disabled Services | 251J00000X | 02971 | ME | N | Agencies | Nursing Care | 251S00000X | 406317 | ME | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 127340000 | 05 | ME | MEDICAID | 127340300 | 05 | ME | MEDICAID | 127340201 | 05 | ME | MEDICAID | 127340400 | 05 | ME | MEDICAID | 127340001 | 05 | ME | MEDICAID | 127340100 | 05 | ME | MEDICAID |