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KRE HUSKY YARMOUTH LICENSEE LLC
NPI 1396630075
Assisted Living Facility - Assisted Living, Mental Illness in Yarmouth, ME

Active since June 11, 2025CLIA 20D2225686 · Waiver
27 FOREST FALLS DR, YARMOUTH, ME 04096(206) 447-9075 Get Directions Write a Review

NPPES record last updated: June 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kre Husky Yarmouth Licensee Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KRE HUSKY YARMOUTH LICENSEE LLC (NPI 1396630075), doing business as Bay Square At Yarmouth, is a healthcare organization registered as an assisted living, mental illness in Yarmouth, Maine and active in the NPI registry since June 2025. The organization holds a CLIA Waiver certificate valid through May 23, 2027 and lists Thomas Grape, President, as its authorized official.

NPPES Registry Identity

NPI1396630075
Entity TypeOrganization
Primary Taxonomy3104A0625X
Legal Business NameKRE HUSKY YARMOUTH LICENSEE LLC
Location Address27 FOREST FALLS DRYarmouth, ME 04096-6972
Mailing Address201 Jones Rd Ste 300Waltham, MA 02451-1618 · (781) 489-7100
Phone(206) 447-9075
Organization SubpartNo
Authorized OfficialThomas GrapePresident · (781) 489-7100
Enumeration DateJune 11, 2025
NPPES CertifiedJune 11, 2025
✔ NPI 1396630075 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Mental IllnessNursing & Custodial Care Facilities
Taxonomy Code3104A0625X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.
27 FOREST FALLS DR, Yarmouth, ME 04096
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Other Names 1

Doing Business AsBay Square At Yarmouth

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 20D2225686

Kre Husky Yarmouth License LLC · Yarmouth, ME
Active · expires May 23, 2027
CLIA Number20D2225686
Laboratory TypeAssisted Living Facility
Certificate Effective DateMay 24, 2025
Certificate Expiration DateMay 23, 2027
Laboratory DirectorMatthew Soroko
Laboratory Phone(207) 846-0044
Laboratory LocationKre Husky Yarmouth License LLC27 Forest Falls Drive, Yarmouth, ME 04096
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kre Husky Yarmouth Licensee LLC's NPI number?

The NPI number for Kre Husky Yarmouth Licensee LLC is 1396630075. It was assigned to this organization in the NPPES registry on June 11, 2025. The provider is doing business as Bay Square at Yarmouth.

Where is Kre Husky Yarmouth Licensee LLC located?

Kre Husky Yarmouth Licensee LLC is located at 27 Forest Falls Dr, Yarmouth, ME 04096. The listed phone number is (206) 447-9075.

What is Kre Husky Yarmouth Licensee LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

Does Kre Husky Yarmouth Licensee LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 20D2225686) is associated with this NPI, valid through May 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kre Husky Yarmouth Licensee LLC was last updated on June 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.