Provider Demographics
NPI:1790820223
Name:WESTERN MAINE NURSING HOME INC
Entity Type:Organization
Organization Name:WESTERN MAINE NURSING HOME INC
Other - Org Name:MARKET SQUARE HEALTH CARE CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-744-6006
Mailing Address - Street 1:3 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-1114
Mailing Address - Country:US
Mailing Address - Phone:207-743-7086
Mailing Address - Fax:207-743-2395
Practice Address - Street 1:3 MARKET SQ
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-1114
Practice Address - Country:US
Practice Address - Phone:207-743-7086
Practice Address - Fax:207-539-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2084314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME165280001Medicaid
ME165280000Medicaid
ME165280001Medicaid