MEDICARE: WOOSTER HILL HOME

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	253Z00000X	In Home Supportive Care Agency	3002907	ME

General Provider Information

NPI Number	:	1558503052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOSTER HILL HOME

Provider Business Mailing Address
First Line	:	277 WOOSTER HILL RD
Second Line	:
City	:	ROME
State	:	ME
Zip	:	04963-3017
Country	:	US
Telephone Number	:	207-397-5035
Fax Number	:	207-397-5411

Provider Business Practice Location Address
First Line	:	277 WOOSTER HILL RD
Second Line	:
City	:	ROME
State	:	ME
Zip	:	04963-3017
Country	:	US
Telephone Number	:	207-397-5035
Fax Number	:	207-397-5411

Authorized Official
Title or Position	:	OWNER
Name	:	MARK PELLETIER
Credential	:
Telephone Number	:	207-397-5035

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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Directions to “WOOSTER HILL HOME ” Practice Location

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