Healthcare Provider Details

I. General information

NPI: 1750357646
Provider Name (Legal Business Name): MAINE VETERANS' HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 HIGH ST
SOUTH PARIS ME
04281-6507
US

IV. Provider business mailing address

477 HIGH ST
SOUTH PARIS ME
04281-6507
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-6300
  • Fax:
Mailing address:
  • Phone: 207-743-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1959
License Number StateME

VIII. Authorized Official

Name: KEVIN J BROOKS
Title or Position: CFO
Credential:
Phone: 207-622-0075