Provider Demographics
NPI:1265676241
Name:ELR CARE MAINE LLC
Entity Type:Organization
Organization Name:ELR CARE MAINE LLC
Other - Org Name:DOLLEY FARM RES CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-2973
Mailing Address - Street 1:98 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3109
Mailing Address - Country:US
Mailing Address - Phone:207-854-4207
Mailing Address - Fax:207-854-0938
Practice Address - Street 1:98 EAST BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3109
Practice Address - Country:US
Practice Address - Phone:207-854-4207
Practice Address - Fax:207-854-0938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELR CARE MAINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-22
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS2625310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME405380001Medicaid