Healthcare Provider Details

I. General information

NPI: 1114363629
Provider Name (Legal Business Name): LANDMARK VISIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 BRICKYARD HILL RD
BRIDGTON ME
04009-4647
US

IV. Provider business mailing address

PO BOX 91
NORTH BRIDGTON ME
04057-0091
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-2791
  • Fax:
Mailing address:
  • Phone: 207-647-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARLES TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 207-647-2791