MEDICARE: WESTERN MAINE NURSING HOME INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	2084	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790820223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN MAINE NURSING HOME INC

Provider Business Mailing Address
First Line	:	3 MARKET SQ
Second Line	:
City	:	SOUTH PARIS
State	:	ME
Zip	:	04281-1114
Country	:	US
Telephone Number	:	207-743-7086
Fax Number	:	207-743-2395

Provider Business Practice Location Address
First Line	:	3 MARKET SQ
Second Line	:
City	:	SOUTH PARIS
State	:	ME
Zip	:	04281-1114
Country	:	US
Telephone Number	:	207-743-7086
Fax Number	:	207-539-6002

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. DIANA J MCLAUGHLIN
Credential	:
Telephone Number	:	207-744-6006

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/19/2012

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