Provider Demographics
NPI:1679012157
Name:MAINE FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:MAINE FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXUCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:COFFIN
Authorized Official - Last Name:L
Authorized Official - Suffix:
Authorized Official - Credentials:BHP,CRMA,DSP,BFA
Authorized Official - Phone:207-272-2723
Mailing Address - Street 1:95 NARRAGANSETT ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1411
Mailing Address - Country:US
Mailing Address - Phone:207-272-2723
Mailing Address - Fax:
Practice Address - Street 1:95 NARRAGANSETT ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1411
Practice Address - Country:US
Practice Address - Phone:207-272-2723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERCA38665310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERCA38665OtherASSISTED LIVING FACILITY