Healthcare Provider Details

I. General information

NPI: 1427026657
Provider Name (Legal Business Name): FREEPORT CONVALESCENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OLD COUNTY RD
FREEPORT ME
04032-6231
US

IV. Provider business mailing address

6 OLD COUNTY RD
FREEPORT ME
04032-6231
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-4782
  • Fax: 207-865-1308
Mailing address:
  • Phone: 207-865-4782
  • Fax: 207-865-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2005
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2005
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number2005
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2103
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number2103
License Number StateME
# 6
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2005
License Number StateME

VIII. Authorized Official

Name: KENNETH BOWDEN
Title or Position: CEO
Credential:
Phone: 207-874-2700