Provider Demographics
NPI:1750668018
Name:YELLOW DOG ENTERPRISES, INC.
Entity Type:Organization
Organization Name:YELLOW DOG ENTERPRISES, INC.
Other - Org Name:FIRST LIGHT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-627-1125
Mailing Address - Street 1:51 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-4138
Mailing Address - Country:US
Mailing Address - Phone:207-627-1125
Mailing Address - Fax:207-627-1126
Practice Address - Street 1:51 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-4138
Practice Address - Country:US
Practice Address - Phone:207-627-1125
Practice Address - Fax:207-627-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care