Provider Demographics
NPI:1326282039
Name:JACOBS RESIDENTIAL CARE CENTER, INC.
Entity Type:Organization
Organization Name:JACOBS RESIDENTIAL CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-696-4466
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:7 CHURCH ST
Mailing Address - City:ANSON
Mailing Address - State:ME
Mailing Address - Zip Code:04911-0322
Mailing Address - Country:US
Mailing Address - Phone:207-696-4466
Mailing Address - Fax:207-696-4466
Practice Address - Street 1:7 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:ME
Practice Address - Zip Code:04911-0322
Practice Address - Country:US
Practice Address - Phone:207-696-4466
Practice Address - Fax:207-696-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3393315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities