Organization
FALLBROOK INC
Active
Other names
Fallbrook Woods
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J FEENEY ADMINISTRATOR (PRESIDENT ADMINISTRATOR)
(207) 878-0788
Entity
Organization
Contact information
Practice address
418 RAYSTREET, PORTLAND, ME 04103
(207) 878-0788
(207) 878-7734
Mailing address
418 RAY STREET, PORTLAND, ME 04103
(207) 878-0788
(207) 878-7734
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
372595
ME
311Z00000X
Custodial Care Facility
372595
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123760000
—
ME
Enumeration date
05/27/2008
Last updated
05/27/2008
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