Healthcare Provider Details

I. General information

NPI: 1013907252
Provider Name (Legal Business Name): HIGH VIEW MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 RIVERVIEW ST
MADAWASKA ME
04756-1024
US

IV. Provider business mailing address

517 RIVERVIEW ST
MADAWASKA ME
04756-1024
US

V. Phone/Fax

Practice location:
  • Phone: 207-728-3338
  • Fax: 207-728-4397
Mailing address:
  • Phone: 207-728-3338
  • Fax: 207-728-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1930
License Number StateMA

VIII. Authorized Official

Name: MR. LOUIS GEORGE DUGAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 207-728-3338