Provider Demographics
NPI:1295820652
Name:ST. ANDREWS HOSPITAL
Entity Type:Organization
Organization Name:ST. ANDREWS HOSPITAL
Other - Org Name:ST. ANDREWS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-633-8413
Mailing Address - Street 1:P.O. BOX 417
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-0417
Mailing Address - Country:US
Mailing Address - Phone:207-633-1919
Mailing Address - Fax:207-633-1224
Practice Address - Street 1:6 ST. ANDREWS LANE
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-0417
Practice Address - Country:US
Practice Address - Phone:207-633-1919
Practice Address - Fax:207-633-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME207029Medicare ID - Type UnspecifiedHOME HEALTH AGENCY