Provider Demographics
NPI:1598762056
Name:ELRCARE MAINE LLC
Entity Type:Organization
Organization Name:ELRCARE MAINE LLC
Other - Org Name:
Other - Org Type:
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:P.O. BOX 15
Mailing Address - Street 2:15 MAIN STREET
Mailing Address - City:PENOBSCOT
Mailing Address - State:ME
Mailing Address - Zip Code:04476-0015
Mailing Address - Country:US
Mailing Address - Phone:207-326-4344
Mailing Address - Fax:207-326-9615
Practice Address - Street 1:15 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PENOBSCOT
Practice Address - State:ME
Practice Address - Zip Code:04476-0015
Practice Address - Country:US
Practice Address - Phone:207-326-4344
Practice Address - Fax:207-326-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2407314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME405380006Medicaid
ME405380006Medicaid