Provider Demographics
NPI:1447354576
Name:REDDING HOMES, INC
Entity type:Organization
Organization Name:REDDING HOMES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-597-2510
Mailing Address - Street 1:26 PLEASANT STREET
Mailing Address - Street 2:PO BOX 636
Mailing Address - City:CANTON
Mailing Address - State:ME
Mailing Address - Zip Code:04221-0636
Mailing Address - Country:US
Mailing Address - Phone:207-597-2510
Mailing Address - Fax:207-597-2580
Practice Address - Street 1:26 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:ME
Practice Address - Zip Code:04221-0636
Practice Address - Country:US
Practice Address - Phone:207-597-2510
Practice Address - Fax:207-597-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 2084261QA0600X
ME2003313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205101Medicare ID - Type Unspecified