Provider Demographics
NPI:1386619609
Name:MAINE VETERANS' HOMES
Entity type:Organization
Organization Name:MAINE VETERANS' HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-622-0075
Mailing Address - Street 1:310 CONY RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-0513
Mailing Address - Country:US
Mailing Address - Phone:207-622-2454
Mailing Address - Fax:
Practice Address - Street 1:310 CONY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0513
Practice Address - Country:US
Practice Address - Phone:207-622-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1907310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111920008Medicaid