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General NPI Number Information
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NPI Number | 1659569218
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Entity Type | Organization
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Legal Business Name | KENNISON FAMILY FOSTER HOME
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 353 GREENWOOD RD
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City | NORWAY
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State | ME
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Zip | 04268-4402
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Country | US
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Telephone | 207-527-2405
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Fax |
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Provider Business Mailing Address
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Address Line | 353 GREENWOOD RD
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City | NORWAY
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State | ME
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Zip | 04268-4402
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Country | US
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Telephone | 207-527-2405
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DONNA M. KENNISON
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Credential | HOME PROVIDER
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Telephone | 207-527-2405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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