Provider Demographics
NPI:1710440714
Name:WOODLANDS SENIOR LIVING OF MADISON LLC
Entity Type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-8992
Mailing Address - Street 1:141 W RIVER RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5184
Mailing Address - Country:US
Mailing Address - Phone:207-872-8992
Mailing Address - Fax:207-861-7072
Practice Address - Street 1:141 W RIVER RD STE 400
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5184
Practice Address - Country:US
Practice Address - Phone:207-872-8992
Practice Address - Fax:207-861-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)