Provider Demographics
NPI:1184719734
Name:SEQUELCARE OF MAINE, LLC
Entity type:Organization
Organization Name:SEQUELCARE OF MAINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-880-6193
Mailing Address - Street 1:500 ROUTE 1 STE 102
Mailing Address - Street 2:PO BOX 1397
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6816
Mailing Address - Country:US
Mailing Address - Phone:207-847-2273
Mailing Address - Fax:207-847-2017
Practice Address - Street 1:500 ROUTE 1
Practice Address - Street 2:SUITE 102
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096
Practice Address - Country:US
Practice Address - Phone:207-847-2273
Practice Address - Fax:207-847-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME02730251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME207039Medicare UPIN