Provider Demographics
NPI:1447484704
Name:OCEAN WAY MANOR INC
Entity type:Organization
Organization Name:OCEAN WAY MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TARDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-354-8184
Mailing Address - Street 1:53 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3031
Mailing Address - Country:US
Mailing Address - Phone:207-354-8184
Mailing Address - Fax:
Practice Address - Street 1:53 GRANITE ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3031
Practice Address - Country:US
Practice Address - Phone:207-354-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME320900000X320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201320000OtherPROVIDER