Provider Demographics
NPI:1730414921
Name:WOODSIDE RESIDENTIAL, INC
Entity type:Organization
Organization Name:WOODSIDE RESIDENTIAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-737-2443
Mailing Address - Street 1:814 ALEXANDER REED RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357-3411
Mailing Address - Country:US
Mailing Address - Phone:207-737-2443
Mailing Address - Fax:207-737-2443
Practice Address - Street 1:54 BARROWS DR
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1324
Practice Address - Country:US
Practice Address - Phone:207-725-9330
Practice Address - Fax:207-725-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 3081320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities