Provider Demographics
NPI:1518940352
Name:SOUTHWEST HARBOR-TREMONT NURSING SERVICE, INC
Entity Type:Organization
Organization Name:SOUTHWEST HARBOR-TREMONT NURSING SERVICE, INC
Other - Org Name:SOUTHWEST HARBOR-TREMONT NURSING SERVICE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIKER
Authorized Official - Suffix:
Authorized Official - Credentials:TREASURER
Authorized Official - Phone:207-244-5554
Mailing Address - Street 1:24 VILLAGE GREEN WAY
Mailing Address - Street 2:P O BOX 437
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-4262
Mailing Address - Country:US
Mailing Address - Phone:207-244-5554
Mailing Address - Fax:207-359-0911
Practice Address - Street 1:24 VILLAGE GREEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4262
Practice Address - Country:US
Practice Address - Phone:207-244-5554
Practice Address - Fax:207-359-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6653416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103350000Medicaid
ME=========OtherTAX ID NUMBER
ME=========OtherTAX ID NUMBER