1790752921 NPI number — WOODLANDS SENIOR LIVING OF HALLOWELL, LLC

Table of content: (NPI 1790752921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790752921 NPI number — WOODLANDS SENIOR LIVING OF HALLOWELL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLANDS SENIOR LIVING OF HALLOWELL, LLC
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:
1790752921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 W RIVER RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-5098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-872-8992
Provider Business Mailing Address Fax Number:
207-861-7072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 WINTHROP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALLOWELL
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04347-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-623-3396
Provider Business Practice Location Address Fax Number:
207-623-2959
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIROIS
Authorized Official First Name:
JILL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PROFESSIONAL SERVICES CONSULTANT
Authorized Official Telephone Number:
207-872-8992

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALLS2169 , 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: 1790752921 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com