Provider Demographics
NPI:1255315263
Name:HIBBARD NURSING HOME INC
Entity Type:Organization
Organization Name:HIBBARD NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBARD MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR OWNER
Authorized Official - Phone:207-564-8129
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0159
Mailing Address - Country:US
Mailing Address - Phone:207-564-8129
Mailing Address - Fax:207-564-8484
Practice Address - Street 1:1037 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-3752
Practice Address - Country:US
Practice Address - Phone:207-564-8129
Practice Address - Fax:207-564-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36293314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205004Medicare ID - Type Unspecified