Provider Demographics
NPI:1942291281
Name:CLOVER MANOR INC
Entity Type:Organization
Organization Name:CLOVER MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-782-4797
Mailing Address - Street 1:250 GODDARD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1000
Mailing Address - Country:US
Mailing Address - Phone:207-782-4797
Mailing Address - Fax:207-777-3996
Practice Address - Street 1:440 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4332
Practice Address - Country:US
Practice Address - Phone:207-784-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME106170100Medicaid
ME106170000Medicaid
ME106170002Medicaid
ME106170001Medicaid
ME106170002Medicaid