Provider Demographics
NPI:1659362481
Name:MAINE GENERAL HEALTH REHABILITATION & LONG TERM CARE
Entity Type:Organization
Organization Name:MAINE GENERAL HEALTH REHABILITATION & LONG TERM CARE
Other - Org Name:KENNEBEC LONG TERM CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NONA
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOYINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-2611
Mailing Address - Street 1:37 GRAY BIRCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6105
Mailing Address - Country:US
Mailing Address - Phone:207-621-7100
Mailing Address - Fax:207-621-7101
Practice Address - Street 1:37 GRAY BIRCH DRIVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6105
Practice Address - Country:US
Practice Address - Phone:207-621-7100
Practice Address - Fax:207-621-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1927314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME999202253Medicaid
ME999202253Medicaid
ME999202253Medicaid