Provider Demographics
NPI:1124771522
Name:FAMILY ENTERPRISES
Entity type:Organization
Organization Name:FAMILY ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-460-9303
Mailing Address - Street 1:510 LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04410-3226
Mailing Address - Country:US
Mailing Address - Phone:207-460-9303
Mailing Address - Fax:888-460-3866
Practice Address - Street 1:532 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3751
Practice Address - Country:US
Practice Address - Phone:207-907-4450
Practice Address - Fax:888-460-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility