Provider Demographics
NPI:1164264065
Name:LEGACY SWEET HOMES LLC
Entity type:Organization
Organization Name:LEGACY SWEET HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-287-8834
Mailing Address - Street 1:170 LANE RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:ME
Mailing Address - Zip Code:04236-3111
Mailing Address - Country:US
Mailing Address - Phone:774-287-8834
Mailing Address - Fax:
Practice Address - Street 1:170 LANE RD
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:ME
Practice Address - Zip Code:04236-3111
Practice Address - Country:US
Practice Address - Phone:774-287-8834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances