Provider Demographics
NPI:1235126442
Name:ST. JOSEPHS OPERATING COMPANY INC
Entity Type:Organization
Organization Name:ST. JOSEPHS OPERATING COMPANY INC
Other - Org Name:ST. JOSEPH NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-594-4974
Mailing Address - Street 1:426 US ROUTE 1
Mailing Address - Street 2:P.O. BOX 469
Mailing Address - City:FRENCHVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04745-6155
Mailing Address - Country:US
Mailing Address - Phone:207-543-6648
Mailing Address - Fax:207-543-6118
Practice Address - Street 1:426 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:FRENCHVILLE
Practice Address - State:ME
Practice Address - Zip Code:04745-6155
Practice Address - Country:US
Practice Address - Phone:207-543-6648
Practice Address - Fax:207-543-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36337313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104410000Medicaid
ME433035100Medicaid
ME104410000Medicaid