Provider Demographics
NPI:1013508514
Name:SOLACE CARE
Entity Type:Organization
Organization Name:SOLACE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TATARCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-361-7411
Mailing Address - Street 1:252 LITTLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-5108
Mailing Address - Country:US
Mailing Address - Phone:207-361-7411
Mailing Address - Fax:
Practice Address - Street 1:252 LITTLEFIELD RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-5108
Practice Address - Country:US
Practice Address - Phone:207-361-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMETPID010642Medicaid