Provider Demographics
NPI:1235628934
Name:WOODLANDS SENIOR LIVING OF FARMINGTON, LLC
Entity Type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF FARMINGTON, LLC
Other - Org Name:WOODLANDS ASSISTED LIVING OF FARMINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-8992
Mailing Address - Street 1:175 KNOWLTON CORNER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6200
Mailing Address - Country:US
Mailing Address - Phone:207-872-8992
Mailing Address - Fax:207-861-7072
Practice Address - Street 1:175 KNOWLTON CORNER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6200
Practice Address - Country:US
Practice Address - Phone:207-872-8992
Practice Address - Fax:207-861-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPENDING310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility