Healthcare Provider Details

I. General information

NPI: 1699073080
Provider Name (Legal Business Name): HORIZONS LIVING AND REHAB CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MAURICE DR
BRUNSWICK ME
04011-3270
US

IV. Provider business mailing address

29 MAURICE DR
BRUNSWICK ME
04011-3270
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-7495
  • Fax: 207-725-7195
Mailing address:
  • Phone: 207-725-7495
  • Fax: 207-725-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MITCHELL A. ROUSSEAU
Title or Position: PRESIDENT
Credential:
Phone: 207-725-4071