Healthcare Provider Details

I. General information

NPI: 1720167901
Provider Name (Legal Business Name): NOLI TRPINAWZK CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SARAHS SPRING LN
INDIAN ISLAND ME
04468-1270
US

IV. Provider business mailing address

2 SARAHS SPRING LN
INDIAN ISLAND ME
04468-1270
US

V. Phone/Fax

Practice location:
  • Phone: 207-827-0968
  • Fax: 207-827-4016
Mailing address:
  • Phone: 207-827-0968
  • Fax: 207-827-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALLS 2138
License Number StateME

VIII. Authorized Official

Name: MRS. PATRICIA E KNOX-NICOLA
Title or Position: PRESIDENT
Credential:
Phone: 207-817-7400