Healthcare Provider Details

I. General information

NPI: 1154322808
Provider Name (Legal Business Name): FRYEBURG HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 FAIRVIEW DR
FRYEBURG ME
04037-1524
US

IV. Provider business mailing address

197 SUMMER ST
AUBURN ME
04210-5125
US

V. Phone/Fax

Practice location:
  • Phone: 207-786-0111
  • Fax: 207-783-5016
Mailing address:
  • Phone: 207-786-0111
  • Fax: 207-783-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1942
License Number StateME

VIII. Authorized Official

Name: MR. DAVID R. HICKS
Title or Position: OWNER
Credential:
Phone: 207-786-0111