Provider Demographics
NPI:1609003623
Name:THE ELMS PERSONAL CARE HOME, INC.
Entity Type:Organization
Organization Name:THE ELMS PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-399-3707
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:35 ELM ST.
Mailing Address - City:NORTH ANSON
Mailing Address - State:ME
Mailing Address - Zip Code:04958-0006
Mailing Address - Country:US
Mailing Address - Phone:207-635-2567
Mailing Address - Fax:
Practice Address - Street 1:35 ELM ST.
Practice Address - Street 2:
Practice Address - City:NORTH ANSON
Practice Address - State:ME
Practice Address - Zip Code:04958
Practice Address - Country:US
Practice Address - Phone:207-635-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 3621320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114810000Medicaid