Provider Demographics
NPI:1003164682
Name:AMERICOAST MAINE LLC
Entity Type:Organization
Organization Name:AMERICOAST MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WATTS-GORMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-568-2236
Mailing Address - Street 1:214 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1119
Mailing Address - Country:US
Mailing Address - Phone:207-834-9094
Mailing Address - Fax:207-834-9097
Practice Address - Street 1:214 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1119
Practice Address - Country:US
Practice Address - Phone:207-834-9094
Practice Address - Fax:207-834-9097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-29
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies