Provider Demographics
NPI:1568902443
Name:SIXTY THREE WASHINGTON ST. HOME FOR SENIORS
Entity Type:Organization
Organization Name:SIXTY THREE WASHINGTON ST. HOME FOR SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR2072363638
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-236-3638
Mailing Address - Street 1:63 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1581
Mailing Address - Country:US
Mailing Address - Phone:207-236-3638
Mailing Address - Fax:207-236-3638
Practice Address - Street 1:63 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1581
Practice Address - Country:US
Practice Address - Phone:207-236-3638
Practice Address - Fax:207-236-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERCC992310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility