Provider Demographics
NPI:1730323148
Name:SOUTHERN ACRES RESIDENTIAL CARE FACILITY INC.
Entity Type:Organization
Organization Name:SOUTHERN ACRES RESIDENTIAL CARE FACILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-429-9231
Mailing Address - Street 1:203 TWEEDIE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04787-3216
Mailing Address - Country:US
Mailing Address - Phone:207-429-9231
Mailing Address - Fax:207-429-9611
Practice Address - Street 1:203 TWEEDIE RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:ME
Practice Address - Zip Code:04787-3216
Practice Address - Country:US
Practice Address - Phone:207-429-9231
Practice Address - Fax:207-429-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS2420310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME123580000OtherPROVIDER NUMBER