Provider Demographics
NPI:1346471836
Name:PITTSFIELD COMMUNITY HOME, LLC
Entity Type:Organization
Organization Name:PITTSFIELD COMMUNITY HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-6889
Mailing Address - Street 1:554 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-3703
Mailing Address - Country:US
Mailing Address - Phone:207-487-6889
Mailing Address - Fax:207-487-4751
Practice Address - Street 1:554 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-3703
Practice Address - Country:US
Practice Address - Phone:207-487-6889
Practice Address - Fax:207-487-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3186310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432508100OtherMAINECARE PROVIDER NUMBER