Provider Demographics
NPI:1326403569
Name:DLTC HEALTHCARE LLC
Entity Type:Organization
Organization Name:DLTC HEALTHCARE LLC
Other - Org Name:BAYVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-594-4990
Mailing Address - Street 1:18 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2959
Mailing Address - Country:US
Mailing Address - Phone:207-594-4990
Mailing Address - Fax:
Practice Address - Street 1:45 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974
Practice Address - Country:US
Practice Address - Phone:207-548-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIS LONG TERM CARE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility