Provider Demographics
NPI:1699771980
Name:SEBASTICOOK VALLEY HOME CARE
Entity type:Organization
Organization Name:SEBASTICOOK VALLEY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-5141
Mailing Address - Street 1:49 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967
Mailing Address - Country:US
Mailing Address - Phone:207-487-3726
Mailing Address - Fax:207-487-5740
Practice Address - Street 1:49 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967
Practice Address - Country:US
Practice Address - Phone:207-487-3726
Practice Address - Fax:207-487-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02579251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME207072Medicare ID - Type Unspecified