Healthcare Provider Details

I. General information

NPI: 1225411036
Provider Name (Legal Business Name): WOODLANDS SENIOR LIVING OF LEWISTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOLLISON WAY
LEWISTON ME
04240
US

IV. Provider business mailing address

141 WEST RIVER ROAD SUITE 300
WATERVILLE ME
04901
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-8992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JILL SIROIS
Title or Position: DIRECTOR OF PROFESSIONAL SERVICES
Credential:
Phone: 207-872-8992