Provider Demographics
NPI:1750873592
Name:SOUTHERN HARBOR ELDERCARE SERVICES
Entity type:Organization
Organization Name:SOUTHERN HARBOR ELDERCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-867-4633
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04853
Mailing Address - Country:US
Mailing Address - Phone:207-867-2345
Mailing Address - Fax:207-863-5027
Practice Address - Street 1:12 PULPIT HARBOR ROAD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:ME
Practice Address - Zip Code:04853
Practice Address - Country:US
Practice Address - Phone:207-867-2345
Practice Address - Fax:207-863-5027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HARBOR ELDERCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME310400000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility