Healthcare Provider Details

I. General information

NPI: 1285606848
Provider Name (Legal Business Name): WOODLANDS SENIOR LIVING OF WATERVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 W RIVER RD
WATERVILLE ME
04901-5098
US

IV. Provider business mailing address

141 W RIVER RD
WATERVILLE ME
04901-5098
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-5685
  • Fax: 207-861-5684
Mailing address:
  • Phone: 207-861-5685
  • Fax: 207-861-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALLS1968
License Number StateME

VIII. Authorized Official

Name: MS. JILL A SIROIS
Title or Position: PROFESSIONAL SERVICES CONSULTANT
Credential: RN
Phone: 207-872-8992