Provider Demographics
NPI:1356670624
Name:HOMES OF REVIVAL INC.
Entity Type:Organization
Organization Name:HOMES OF REVIVAL INC.
Other - Org Name:ROSE OF SHARON/HAVEN OF REST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-223-5528
Mailing Address - Street 1:984 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04496-3404
Mailing Address - Country:US
Mailing Address - Phone:207-223-5528
Mailing Address - Fax:
Practice Address - Street 1:984 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERPORT
Practice Address - State:ME
Practice Address - Zip Code:04496-3404
Practice Address - Country:US
Practice Address - Phone:207-223-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 3645310400000X
MEALLS 3316310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433036601OtherMAINECARE
ME433036600OtherMAINECARE
ME101430000OtherMAINECARE