1144528571 NPI number — GOLDEN ACRES BOARDING HOME

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144528571 NPI number — GOLDEN ACRES BOARDING HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN ACRES BOARDING HOME
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:
6
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:
1144528571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04634-3114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-460-3825
Provider Business Mailing Address Fax Number:
207-565-2352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 PATTEN POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURRY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04684-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-460-3825
Provider Business Practice Location Address Fax Number:
207-565-2352
Provider Enumeration Date:
03/09/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOW
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
RESIDENTIAL FACILITY ADMINISTRATOR
Authorized Official Telephone Number:
207-460-3825

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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