Provider Demographics
NPI:1356962096
Name:CHAMBERS, JOHN VICTOR SR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VICTOR
Last Name:CHAMBERS
Suffix:SR
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 1:152 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1324
Mailing Address - Country:US
Mailing Address - Phone:207-454-8961
Mailing Address - Fax:207-454-8964
Practice Address - Street 1:152 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1324
Practice Address - Country:US
Practice Address - Phone:207-454-8961
Practice Address - Fax:207-454-8964
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
ME3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness