1730323148 NPI number — SOUTHERN ACRES RESIDENTIAL CARE FACILITY INC.

Table of content: (NPI 1730323148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730323148 NPI number — SOUTHERN ACRES RESIDENTIAL CARE FACILITY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN ACRES RESIDENTIAL CARE FACILITY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730323148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 TWEEDIE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04787-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-429-9231
Provider Business Mailing Address Fax Number:
207-429-9611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 TWEEDIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04787-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-429-9231
Provider Business Practice Location Address Fax Number:
207-429-9611
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
207-429-9231

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALLS2420 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 123580000 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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