Provider Demographics
NPI:1518939172
Name:WOODLANDS SENIOR LIVING OF BREWER, LLC
Entity Type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF BREWER, LLC
Other - Org Name:WOODLANDS ASSISTED LIVING OF BREWER
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 1:53 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1448
Mailing Address - Country:US
Mailing Address - Phone:207-989-7577
Mailing Address - Fax:207-989-0577
Practice Address - Street 1:53 COLONIAL CIR
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1448
Practice Address - Country:US
Practice Address - Phone:207-989-7577
Practice Address - Fax:207-989-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME132990000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132990000Medicaid