Healthcare Provider Details

I. General information

NPI: 1851437982
Provider Name (Legal Business Name): PLEASANT RIVER HOMESTEAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E SIDE RD
ADDISON ME
04606-3217
US

IV. Provider business mailing address

380 E SIDE RD
ADDISON ME
04606-3217
US

V. Phone/Fax

Practice location:
  • Phone: 207-483-2884
  • Fax:
Mailing address:
  • Phone: 207-483-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DENISE B. BATSON HANDY
Title or Position: DENISE BATSON
Credential: DSP & CRMA CERTIFIED
Phone: 207-483-2884