Provider Demographics
NPI:1407841083
Name:INDEPENDENT ORDER OF ODD FELLOWS HOME OF MAINE
Entity type:Organization
Organization Name:INDEPENDENT ORDER OF ODD FELLOWS HOME OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO-ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUT
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:207-786-4616
Mailing Address - Street 1:85 CARON LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4288
Mailing Address - Country:US
Mailing Address - Phone:207-786-4616
Mailing Address - Fax:207-786-4064
Practice Address - Street 1:85 CARON LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4288
Practice Address - Country:US
Practice Address - Phone:207-786-4616
Practice Address - Fax:207-786-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1910314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102150000Medicaid