Provider Demographics
NPI:1134588379
Name:WHEELOCK, RON STEPHEN
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:STEPHEN
Last Name:WHEELOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 CHISHOLM POND RD
Mailing Address - Street 2:
Mailing Address - City:PALERMO
Mailing Address - State:ME
Mailing Address - Zip Code:04354-7424
Mailing Address - Country:US
Mailing Address - Phone:207-441-2673
Mailing Address - Fax:
Practice Address - Street 1:883 CHISHOLM POND RD
Practice Address - Street 2:
Practice Address - City:PALERMO
Practice Address - State:ME
Practice Address - Zip Code:04354-7424
Practice Address - Country:US
Practice Address - Phone:207-441-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS-6306310400000X, 311Z00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home