Provider Demographics
NPI:1720541246
Name:WITHAM'S RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:WITHAM'S RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WITHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:207-547-3129
Mailing Address - Street 1:198 SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:ME
Mailing Address - Zip Code:04330-2332
Mailing Address - Country:US
Mailing Address - Phone:207-547-3425
Mailing Address - Fax:207-547-3129
Practice Address - Street 1:198 SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:ME
Practice Address - Zip Code:04330-2332
Practice Address - Country:US
Practice Address - Phone:207-547-3425
Practice Address - Fax:207-547-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities