Provider Demographics
NPI:1245232347
Name:ANDROSCOGGIN HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ANDROSCOGGIN HOME HEALTH SERVICES, INC.
Other - Org Name:ANDROSCOGGIN HOME HEALTHCARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-795-9442
Mailing Address - Street 1:15 STRAWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5941
Mailing Address - Country:US
Mailing Address - Phone:207-777-7740
Mailing Address - Fax:207-777-7748
Practice Address - Street 1:15 STRAWBERRY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5941
Practice Address - Country:US
Practice Address - Phone:207-777-7740
Practice Address - Fax:207-777-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02602251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102360100Medicaid
ME000253OtherANTHEM
ME1040980OtherAETNA
ME20-7019Medicare ID - Type UnspecifiedHOME HEALTH CARE