Provider Demographics
NPI:1629065503
Name:ST. ANDRE HEALTH CARE FACILITY
Entity Type:Organization
Organization Name:ST. ANDRE HEALTH CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON-HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-282-5171
Mailing Address - Street 1:407 POOL ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9714
Mailing Address - Country:US
Mailing Address - Phone:207-282-5171
Mailing Address - Fax:207-282-5372
Practice Address - Street 1:407 POOL ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9714
Practice Address - Country:US
Practice Address - Phone:207-282-5171
Practice Address - Fax:207-282-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36288314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
205108Medicare ID - Type Unspecified