Provider Demographics
NPI:1497989412
Name:ISLAND COMMONS RESOURCE CENTER
Entity Type:Organization
Organization Name:ISLAND COMMONS RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-846-5610
Mailing Address - Street 1:132 LITTLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHEBEAGUE ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04017-3316
Mailing Address - Country:US
Mailing Address - Phone:207-846-4456
Mailing Address - Fax:207-846-9706
Practice Address - Street 1:132 LITTLEFIELD RD
Practice Address - Street 2:
Practice Address - City:CHEBEAGUE ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04017-3316
Practice Address - Country:US
Practice Address - Phone:207-846-4456
Practice Address - Fax:207-846-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3138310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility