Provider Demographics
NPI:1235686239
Name:ROSE OF SHARON/HAVEN OF REST
Entity type:Organization
Organization Name:ROSE OF SHARON/HAVEN OF REST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-223-5528
Mailing Address - Street 1:984 NORTH MAIN STREET
Mailing Address - Street 2:PO BOX 649
Mailing Address - City:WINTERPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04496
Mailing Address - Country:US
Mailing Address - Phone:207-223-5528
Mailing Address - Fax:
Practice Address - Street 1:984 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WINTERPORT
Practice Address - State:ME
Practice Address - Zip Code:04496
Practice Address - Country:US
Practice Address - Phone:207-223-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS6501310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433036601OtherMAINECARE
ME433036601Medicaid