Healthcare Provider Details

I. General information

NPI: 1861481384
Provider Name (Legal Business Name): ISLAND NURSING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 N DEER ISLE RD
DEER ISLE ME
04627-3438
US

IV. Provider business mailing address

587 N DEER ISLE RD
DEER ISLE ME
04627-3438
US

V. Phone/Fax

Practice location:
  • Phone: 207-348-2351
  • Fax:
Mailing address:
  • Phone: 207-348-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1903
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1903
License Number StateME

VIII. Authorized Official

Name: DEBORAH ADKINS
Title or Position: FINANCIAL CONTROLLER
Credential:
Phone: 207-348-2351