Provider Demographics
NPI:1558505883
Name:LIBBY'S FOSTER HOME
Entity Type:Organization
Organization Name:LIBBY'S FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-793-4567
Mailing Address - Street 1:123 DEMERITT RD
Mailing Address - Street 2:
Mailing Address - City:WEST NEWFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04095-3427
Mailing Address - Country:US
Mailing Address - Phone:207-793-4567
Mailing Address - Fax:
Practice Address - Street 1:123 DEMERITT RD
Practice Address - Street 2:
Practice Address - City:WEST NEWFIELD
Practice Address - State:ME
Practice Address - Zip Code:04095-3427
Practice Address - Country:US
Practice Address - Phone:207-793-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========Medicaid