Provider Demographics
NPI:1194489674
Name:WOODLANDS SENIOR LIVING OF BRIDGTON
Entity type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF BRIDGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-504-0659
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:941-504-0659
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGH STREET
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-872-8992
Practice Address - Fax:207-872-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)