Provider Demographics
NPI:1164475281
Name:EASTERN MAINE HOMECARE
Entity Type:Organization
Organization Name:EASTERN MAINE HOMECARE
Other - Org Name:BANGOR AREA VISITING NURSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOUCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-498-2578
Mailing Address - Street 1:885 UNION ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3083
Mailing Address - Country:US
Mailing Address - Phone:207-973-6550
Mailing Address - Fax:207-973-6557
Practice Address - Street 1:885 UNION ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3083
Practice Address - Country:US
Practice Address - Phone:207-973-6550
Practice Address - Fax:207-973-6556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN MAIN HOMECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02768251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101740000Medicaid
ME101740000Medicaid