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Organization
MAGNOLIA JED PROUTY
Active
Organization
MAGNOLIA JED PROUTY
Active
Other names
Evergreen Assisted Living, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR MORRIS (CEO)
(207) 702-0144
Entity
Organization
Contact information
Practice address
57 MAIN ST, BUCKSPORT, ME 04416-4115
(207) 902-1220
(207) 902-1230
Mailing address
175 EXCHANGE ST STE 240, BANGOR, ME 04401-7408
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/31/2025
Last updated
01/31/2025
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