Provider Demographics
NPI:1578662607
Name:WARDWELL ASSISTED LIVING SERVICES, INC
Entity Type:Organization
Organization Name:WARDWELL ASSISTED LIVING SERVICES, INC
Other - Org Name:WARDWELL HOME FOR THE AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-284-7061
Mailing Address - Street 1:43 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3300
Mailing Address - Country:US
Mailing Address - Phone:207-284-7061
Mailing Address - Fax:207-283-9642
Practice Address - Street 1:43 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3300
Practice Address - Country:US
Practice Address - Phone:207-284-7061
Practice Address - Fax:207-283-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 2020310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility