Provider Demographics
NPI:1972743110
Name:ST REMIE'S FOSTER HOME
Entity Type:Organization
Organization Name:ST REMIE'S FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOSTER HOME OPOERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-868-5625
Mailing Address - Street 1:109 CHURCH ST
Mailing Address - Street 2:PO BOX 138
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1445
Mailing Address - Country:US
Mailing Address - Phone:207-868-5625
Mailing Address - Fax:207-868-5625
Practice Address - Street 1:109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1445
Practice Address - Country:US
Practice Address - Phone:207-868-5625
Practice Address - Fax:207-868-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME206850001Medicaid