Provider Demographics
NPI:1538133491
Name:MAINE VETERANS' HOME
Entity Type:Organization
Organization Name:MAINE VETERANS' HOME
Other - Org Name:MAINE VETERANS' HOMES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-622-0075
Mailing Address - Street 1:44 HOGAN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5602
Mailing Address - Country:US
Mailing Address - Phone:207-942-2333
Mailing Address - Fax:207-942-4810
Practice Address - Street 1:44 HOGAN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5602
Practice Address - Country:US
Practice Address - Phone:207-942-2333
Practice Address - Fax:207-942-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1972314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111920002Medicaid
ME205185Medicare Oscar/Certification