Provider Demographics
NPI:1982693537
Name:SCHOONER RETIREMENT COMMUNITY, INC
Entity Type:Organization
Organization Name:SCHOONER RETIREMENT COMMUNITY, INC
Other - Org Name:SCHOONER ESTATES SEVILLE PARK PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-784-2900
Mailing Address - Street 1:200 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6458
Mailing Address - Country:US
Mailing Address - Phone:207-784-2900
Mailing Address - Fax:207-784-2900
Practice Address - Street 1:200 STETSON RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6458
Practice Address - Country:US
Practice Address - Phone:207-784-2900
Practice Address - Fax:207-784-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11676000Medicaid