Provider Demographics
NPI:1487966792
Name:WOODLANDS SENIOR LIVING OF CAPE ELIZABETH, LLC
Entity type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF CAPE ELIZABETH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-8992
Mailing Address - Street 1:141 W RIVER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5184
Mailing Address - Country:US
Mailing Address - Phone:207-872-8992
Mailing Address - Fax:207-872-8990
Practice Address - Street 1:126 SCOTT DYER RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2230
Practice Address - Country:US
Practice Address - Phone:207-553-9616
Practice Address - Fax:207-553-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1487966792Medicaid