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General NPI Number Information
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NPI Number | 1104918952
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Entity Type | Organization
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Legal Business Name | SUNSET HOME OF WATERVILLE
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 114 COLLEGE AVE
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City | WATERVILLE
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State | ME
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Zip | 04901-5609
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Country | US
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Telephone | 207-872-8414
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Fax | 207-877-8301
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Provider Business Mailing Address
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Address Line | 114 COLLEGE AVE
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City | WATERVILLE
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State | ME
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Zip | 04901-5609
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Country | US
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Telephone | 207-872-8414
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Fax | 207-877-8301
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SUSAN ELIZABETH WHALEN
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Credential |
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Telephone | 207-872-8414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALLS2306
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License Number State | ME
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