Provider Demographics
NPI:1912044363
Name:MAINEGENERAL REHABILITATION AND LONG TERM CARE
Entity Type:Organization
Organization Name:MAINEGENERAL REHABILITATION AND LONG TERM CARE
Other - Org Name:MAINEGENERAL REHABILITATION AND NURSING CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD-CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-621-7116
Mailing Address - Street 1:37 GRAY BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6105
Mailing Address - Country:US
Mailing Address - Phone:207-621-7100
Mailing Address - Fax:207-621-7101
Practice Address - Street 1:37 GRAY BIRCH DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6105
Practice Address - Country:US
Practice Address - Phone:207-621-7100
Practice Address - Fax:207-621-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2013310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1169Medicaid