Provider Demographics
NPI:1851465967
Name:GROUP HOME FOUNDATION, INC.
Entity Type:Organization
Organization Name:GROUP HOME FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEFKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-338-2080
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0227
Mailing Address - Country:US
Mailing Address - Phone:207-338-2080
Mailing Address - Fax:207-338-2082
Practice Address - Street 1:61 LITTLE RIVER DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6035
Practice Address - Country:US
Practice Address - Phone:207-338-2080
Practice Address - Fax:207-338-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X
ME36453315P00000X
MEALLS1915320900000X
MEALLS1914320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities