Provider Demographics
NPI:1134115876
Name:RUMFORD COMMUNITY HOME CORPORATION
Entity Type:Organization
Organization Name:RUMFORD COMMUNITY HOME CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-786-3554
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:11 JOHN F. KENNEDY LANE
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-0430
Mailing Address - Country:US
Mailing Address - Phone:207-364-7863
Mailing Address - Fax:207-364-2672
Practice Address - Street 1:11 JOHN F KENNEDY LN
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-3636
Practice Address - Country:US
Practice Address - Phone:207-364-7863
Practice Address - Fax:207-364-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1897310400000X, 311500000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME165290000Medicaid
ME165290001Medicaid
ME165290002Medicaid