Provider Demographics
NPI:1346212438
Name:WOODLANDS SENIOR LIVING OF WATERVILLE, INC.
Entity Type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF WATERVILLE, INC.
Other - Org Name:WOODLANDS ASSISTED LIVING OF WATERVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSIONAL SERVICES CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-872-8992
Mailing Address - Street 1:141 W RIVER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5098
Mailing Address - Country:US
Mailing Address - Phone:207-872-8992
Mailing Address - Fax:207-861-7072
Practice Address - Street 1:147 W RIVER RD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5070
Practice Address - Country:US
Practice Address - Phone:207-861-5685
Practice Address - Fax:207-861-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS1990310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127550000Medicaid
MEALLS1990OtherASSISTED LIVING LICENSE #