Provider Demographics
NPI:1225411036
Name:WOODLANDS SENIOR LIVING OF LEWISTON, LLC
Entity Type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF LEWISTON, LLC
Other - Org Name:WOODLANDS MEMORY CARE OF LEWISTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-8992
Mailing Address - Street 1:141 WEST RIVER ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 MOLLISON WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-872-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)