Provider Demographics
NPI:1821122011
Name:WINDHAM RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:WINDHAM RESIDENTIAL CARE FACILITY
Other - Org Name:CAROLS RESIDENTIAL CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-892-7141
Mailing Address - Street 1:495 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4603
Mailing Address - Country:US
Mailing Address - Phone:207-892-7141
Mailing Address - Fax:207-892-6131
Practice Address - Street 1:478 RIVER RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4605
Practice Address - Country:US
Practice Address - Phone:207-892-7141
Practice Address - Fax:207-892-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154870100OtherPROVIDER