MEDICARE: JANUS SUPPORTIVE LIVING SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	ALLS3676	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154479830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANUS SUPPORTIVE LIVING SERVICES INC.

Provider Business Mailing Address
First Line	:	276 RAZORVILLE RD
Second Line	:
City	:	WASHINGTON
State	:	ME
Zip	:	04574-3817
Country	:	US
Telephone Number	:	207-845-2231
Fax Number	:	207-845-2032

Provider Business Practice Location Address
First Line	:	276 RAZORVILLE RD
Second Line	:
City	:	WASHINGTON
State	:	ME
Zip	:	04574-3817
Country	:	US
Telephone Number	:	207-845-2231
Fax Number	:	207-845-2032

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JANICE LOIS NELSON
Credential	:
Telephone Number	:	20784522331

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/24/2009

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