Provider Demographics
NPI:1285870857
Name:WOODLANDS SENIOR LIVING OF ROCKLAND, LLC
Entity type:Organization
Organization Name:WOODLANDS SENIOR LIVING OF ROCKLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP. DIR. OF PROFESSIONAL SERVICES
Authorized Official - Prefix:MS
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:207-872-8992
Mailing Address - Street 1:201 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2534
Mailing Address - Country:US
Mailing Address - Phone:207-593-0383
Mailing Address - Fax:
Practice Address - Street 1:201 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2534
Practice Address - Country:US
Practice Address - Phone:207-593-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-01
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1285870857Medicaid