Provider Demographics
NPI:1154479830
Name:JANUS SUPPORTIVE LIVING SERVICES INC.
Entity Type:Organization
Organization Name:JANUS SUPPORTIVE LIVING SERVICES INC.
Other - Org Name:WASHINGTON MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2078-452-2331
Mailing Address - Street 1:276 RAZORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04574-3817
Mailing Address - Country:US
Mailing Address - Phone:207-845-2231
Mailing Address - Fax:207-845-2032
Practice Address - Street 1:276 RAZORVILLE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:ME
Practice Address - Zip Code:04574-3817
Practice Address - Country:US
Practice Address - Phone:207-845-2231
Practice Address - Fax:207-845-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3676310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME13680000Medicaid