Healthcare Provider Details

I. General information

NPI: 1578567988
Provider Name (Legal Business Name): GREENWOOD NURSING CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 MAIN ST
SANFORD ME
04073-3614
US

IV. Provider business mailing address

1142 MAIN ST
SANFORD ME
04073-3614
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-2273
  • Fax: 207-490-2273
Mailing address:
  • Phone: 207-324-2273
  • Fax: 207-490-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number36135
License Number StateME

VIII. Authorized Official

Name: RICHARD BOISVERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 207-324-2273