Provider Demographics
NPI:1578567988
Name:GREENWOOD NURSING CARE CENTER, INC
Entity Type:Organization
Organization Name:GREENWOOD NURSING CARE CENTER, INC
Other - Org Name:GREENWOOD CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-324-2273
Mailing Address - Street 1:1142 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3614
Mailing Address - Country:US
Mailing Address - Phone:207-324-2273
Mailing Address - Fax:207-490-2273
Practice Address - Street 1:1142 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3614
Practice Address - Country:US
Practice Address - Phone:207-324-2273
Practice Address - Fax:207-490-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36135314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107690000Medicaid
ME107690000Medicaid