Provider Demographics
NPI:1548401474
Name:OLD TOWN RESIDENTIAL SERVICES CORP.
Entity Type:Organization
Organization Name:OLD TOWN RESIDENTIAL SERVICES CORP.
Other - Org Name:THE MEADOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:IONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-827-6151
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-0404
Mailing Address - Country:US
Mailing Address - Phone:207-827-6151
Mailing Address - Fax:207-827-1502
Practice Address - Street 1:110 PERKINS AVE
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1763
Practice Address - Country:US
Practice Address - Phone:207-827-0547
Practice Address - Fax:207-827-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERCA865310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME160470000OtherPROVIDER NUMBER WITH STATE OF MAINE