Healthcare Provider Details

I. General information

NPI: 1033345236
Provider Name (Legal Business Name): ENSIGN BOARDING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 ELM STREET
HARTLAND ME
04943-0685
US

IV. Provider business mailing address

P.O. BOX 685 83 ELM STREET
HARTLAND ME
04943-0685
US

V. Phone/Fax

Practice location:
  • Phone: 207-938-2020
  • Fax: 207-938-3833
Mailing address:
  • Phone: 207-938-2020
  • Fax: 207-938-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberALLS3389
License Number StateME

VIII. Authorized Official

Name: MRS. DEBORAH EVE SMITH
Title or Position: PRESIDENT
Credential:
Phone: 207-938-2020