Provider Demographics
NPI:1689233512
Name:MERCY CARE RESIDENTIAL (MCR(
Entity Type:Organization
Organization Name:MERCY CARE RESIDENTIAL (MCR(
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASMO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-754-9115
Mailing Address - Street 1:PO BOX 3681
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04212-3681
Mailing Address - Country:US
Mailing Address - Phone:207-754-9115
Mailing Address - Fax:
Practice Address - Street 1:95 PARK ST STE 519
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7282
Practice Address - Country:US
Practice Address - Phone:207-754-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities