Provider Demographics
NPI:1962587790
Name:THE LAMP ALZHEIMER'S RESIDENTIAL CARE FACILITY
Entity type:Organization
Organization Name:THE LAMP ALZHEIMER'S RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-353-4318
Mailing Address - Street 1:193 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-6122
Mailing Address - Country:US
Mailing Address - Phone:207-353-4634
Mailing Address - Fax:207-353-8704
Practice Address - Street 1:64 LISBON ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250-6017
Practice Address - Country:US
Practice Address - Phone:207-353-4318
Practice Address - Fax:207-353-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS1644311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103180000Medicaid