Provider Demographics
NPI:1891923934
Name:LEANE F MCMASTER
Entity Type:Organization
Organization Name:LEANE F MCMASTER
Other - Org Name:RANDOLPH HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-242-1551
Mailing Address - Street 1:15 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:ME
Mailing Address - Zip Code:04346-5201
Mailing Address - Country:US
Mailing Address - Phone:207-242-1551
Mailing Address - Fax:
Practice Address - Street 1:15 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:ME
Practice Address - Zip Code:04346-5201
Practice Address - Country:US
Practice Address - Phone:207-242-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-28
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 2065320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities