Provider Demographics
NPI:1366431033
Name:KATAHDIN NURSING HOME
Entity type:Organization
Organization Name:KATAHDIN NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:207-723-4711
Mailing Address - Street 1:22 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-2128
Mailing Address - Country:US
Mailing Address - Phone:207-723-4711
Mailing Address - Fax:207-723-6704
Practice Address - Street 1:22 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-2128
Practice Address - Country:US
Practice Address - Phone:207-723-4711
Practice Address - Fax:207-723-6704
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 Licenses
StateLicense IDTaxonomies
ME36319313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205149Medicare ID - Type Unspecified