Provider Demographics
NPI:1538615224
Name:WOODLANDS SENIOR LIVING OF FARMINGTON, LLC
Entity type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF FARMINGTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR & RISK MGMNT SERVICES CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-8992
Mailing Address - Street 1:175 KNOWLTON CORNER RD.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 KNOWLTON CORNER RD.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-872-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPENDINGOtherMEDICAID NUMBER PENDING