Provider Demographics
NPI:1760626246
Name:ELR CARE MAINE LLC
Entity Type:Organization
Organization Name:ELR CARE MAINE LLC
Other - Org Name:NORTHERN BAY RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-2973
Mailing Address - Street 1:12 NORTH PENOBSCOT ROAD
Mailing Address - Street 2:
Mailing Address - City:PENOBSCOT
Mailing Address - State:ME
Mailing Address - Zip Code:04476
Mailing Address - Country:US
Mailing Address - Phone:207-326-4344
Mailing Address - Fax:207-326-9615
Practice Address - Street 1:12 NORTH PENOBSCOT ROAD
Practice Address - Street 2:
Practice Address - City:PENOBSCOT
Practice Address - State:ME
Practice Address - Zip Code:04476
Practice Address - Country:US
Practice Address - Phone:207-326-4344
Practice Address - Fax:207-326-9615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELR CARE MAINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-28
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2335310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME405380005Medicaid