Healthcare Provider Details

I. General information

NPI: 1558503052
Provider Name (Legal Business Name): WOOSTER HILL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 WOOSTER HILL RD
ROME ME
04963-3017
US

IV. Provider business mailing address

277 WOOSTER HILL RD
ROME ME
04963-3017
US

V. Phone/Fax

Practice location:
  • Phone: 207-397-5035
  • Fax: 207-397-5411
Mailing address:
  • Phone: 207-397-5035
  • Fax: 207-397-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3002907
License Number StateME

VIII. Authorized Official

Name: MARK PELLETIER
Title or Position: OWNER
Credential:
Phone: 207-397-5035