Provider Demographics
NPI:1417514829
Name:ATLANTIC SHORES
Entity Type:Organization
Organization Name:ATLANTIC SHORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-483-8041
Mailing Address - Street 1:100 MARSHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-3121
Mailing Address - Country:US
Mailing Address - Phone:207-483-8041
Mailing Address - Fax:
Practice Address - Street 1:100 MARSHVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3121
Practice Address - Country:US
Practice Address - Phone:207-483-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility