1760626246 NPI number — ELR CARE MAINE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760626246 NPI number — ELR CARE MAINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELR CARE MAINE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHERN BAY RESIDENTIAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760626246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 NORTH PENOBSCOT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENOBSCOT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-326-4344
Provider Business Mailing Address Fax Number:
207-326-9615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 NORTH PENOBSCOT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENOBSCOT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-326-4344
Provider Business Practice Location Address Fax Number:
207-326-9615
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TYLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
RECEIVER
Authorized Official Telephone Number:
207-854-2973

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2335 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 405380005 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com