Healthcare Provider Details

I. General information

NPI: 1255567616
Provider Name (Legal Business Name): THE BURR HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 STATE ST
BREWER ME
04412-1914
US

IV. Provider business mailing address

PO BOX 3715
BREWER ME
04412-3715
US

V. Phone/Fax

Practice location:
  • Phone: 207-944-6328
  • Fax: 207-989-3663
Mailing address:
  • Phone: 207-944-6328
  • Fax: 207-989-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALLS 3177
License Number StateME

VIII. Authorized Official

Name: WENDY C LAINEZ
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 207-944-6328