Healthcare Provider Details

I. General information

NPI: 1942444906
Provider Name (Legal Business Name): ROBERT AND MARY'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEADOW VIEW LN SUITE # 35
ELLSWORTH ME
04605-1547
US

IV. Provider business mailing address

50 MEADOW VIEW LN SUITE # 35
ELLSWORTH ME
04605-1547
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-5449
  • Fax:
Mailing address:
  • Phone: 207-667-5449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberALLS 3175
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberALLS 3166
License Number StateME

VIII. Authorized Official

Name: IDA WALLS PAGE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 20766754499