Provider Demographics
NPI:1033105846
Name:VILLAGE SQUARE HOUSING CORPORATION
Entity Type:Organization
Organization Name:VILLAGE SQUARE HOUSING CORPORATION
Other - Org Name:INN AT VILLAGE SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-839-5101
Mailing Address - Street 1:123 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1084
Mailing Address - Country:US
Mailing Address - Phone:207-839-5101
Mailing Address - Fax:207-839-6008
Practice Address - Street 1:123 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1084
Practice Address - Country:US
Practice Address - Phone:207-839-5101
Practice Address - Fax:207-839-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS1510310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility