Provider Demographics
NPI:1730310475
Name:VINALHAVEN ELDERCARE SERVICES
Entity Type:Organization
Organization Name:VINALHAVEN ELDERCARE SERVICES
Other - Org Name:IVAN CALDERWOOD HOMESTEAD
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-863-9980
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:VINALHAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04863-0624
Mailing Address - Country:US
Mailing Address - Phone:207-863-9980
Mailing Address - Fax:207-863-9986
Practice Address - Street 1:18 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:VINALHAVEN
Practice Address - State:ME
Practice Address - Zip Code:04863-3915
Practice Address - Country:US
Practice Address - Phone:207-863-9980
Practice Address - Fax:207-863-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 3429310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431895700Medicaid