Healthcare Provider Details

I. General information

NPI: 1811093909
Provider Name (Legal Business Name): SEBASTICOOK VALLEY HEALTH CARE FACILITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 LEIGHTON ST
PITTSFIELD ME
04967-3718
US

IV. Provider business mailing address

329 MURRAY HILL DR
MONTPELIER VT
05602-4216
US

V. Phone/Fax

Practice location:
  • Phone: 207-487-3131
  • Fax: 207-487-3435
Mailing address:
  • Phone: 603-667-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number36368
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number36368
License Number StateME

VIII. Authorized Official

Name: MARY FORD
Title or Position: OWNER
Credential:
Phone: 603-667-6743