Provider Demographics
NPI:1568601953
Name:SARAH FRYE HOME
Entity Type:Organization
Organization Name:SARAH FRYE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAUCAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-784-7242
Mailing Address - Street 1:751 WASHINGTON ST N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3882
Mailing Address - Country:US
Mailing Address - Phone:207-784-7242
Mailing Address - Fax:207-784-3619
Practice Address - Street 1:751 WASHINGTON ST N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3882
Practice Address - Country:US
Practice Address - Phone:207-784-7242
Practice Address - Fax:207-784-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3073310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102230000Medicaid