Provider Demographics
NPI:1699008276
Name:SENTRY INN @ YORK HARBOR LLC
Entity Type:Organization
Organization Name:SENTRY INN @ YORK HARBOR LLC
Other - Org Name:SENTRY INN
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-782-4797
Mailing Address - Street 1:250 GODDARD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1000
Mailing Address - Country:US
Mailing Address - Phone:207-782-4797
Mailing Address - Fax:207-777-3996
Practice Address - Street 1:2 VICTORIA CT
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1455
Practice Address - Country:US
Practice Address - Phone:207-363-5116
Practice Address - Fax:207-363-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3266310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME130650000Medicaid