Provider Demographics
NPI:1811093909
Name:SEBASTICOOK VALLEY HEALTH CARE FACILITY INC.
Entity type:Organization
Organization Name:SEBASTICOOK VALLEY HEALTH CARE FACILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-667-6743
Mailing Address - Street 1:329 MURRAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4216
Mailing Address - Country:US
Mailing Address - Phone:603-667-6743
Mailing Address - Fax:
Practice Address - Street 1:167 LEIGHTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-3718
Practice Address - Country:US
Practice Address - Phone:207-487-3131
Practice Address - Fax:207-487-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36368313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME108390000Medicaid
205081Medicare ID - Type Unspecified