Organization
FREEPORT CONVALSCENT CENTER
Active
Other names
Hawthorne House
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA PELKEY (CFO)
(207) 874-2700
Entity
Organization
Contact information
Practice address
6 OLD COUNTY RD, FREEPORT, ME 04032-6231
(207) 865-4782
Mailing address
6 OLD COUNTY RD, FREEPORT, ME 04032-6231
(207) 865-4782
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
2005
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115110000
—
ME
Enumeration date
05/19/2009
Last updated
05/19/2009
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