Provider Demographics
NPI:1831323401
Name:CALAIS REGIONAL HOSPITAL HOME HEALTH
Entity Type:Organization
Organization Name:CALAIS REGIONAL HOSPITAL HOME HEALTH
Other - Org Name:CALAIS REGIONAL HOSPITAL LTC PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:HOME HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:207-454-7200
Mailing Address - Street 1:24 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1329
Mailing Address - Country:US
Mailing Address - Phone:207-454-7200
Mailing Address - Fax:207-454-7288
Practice Address - Street 1:43 PALMER ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1305
Practice Address - Country:US
Practice Address - Phone:207-454-7200
Practice Address - Fax:207-454-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02644251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101960200Medicaid
ME101960200Medicaid