Organization
ROUSSEAU ENTERPRISES LLC
Active
Other names
Montello Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH BOWDEN (CEO)
(207) 874-2700
Entity
Organization
Contact information
Practice address
540 COLLEGE ST, LEWISTON, ME 04240-5228
(207) 783-2039
(207) 782-0184
Mailing address
540 COLLEGE ST, LEWISTON, ME 04240-5228
(207) 783-2039
(207) 782-0184
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
1787
ME
314000000X
Skilled Nursing Facility
Primary
1787
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111890002
—
ME
Enumeration date
09/07/2005
Last updated
08/25/2015
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