Provider Demographics
NPI:1649026832
Name:FALLBROOK CARE OPERATIONS, LLC
Entity type:Organization
Organization Name:FALLBROOK CARE OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-786-3554
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-1408
Mailing Address - Country:US
Mailing Address - Phone:207-786-3554
Mailing Address - Fax:207-786-8507
Practice Address - Street 1:91 MERRYMEETING DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3959
Practice Address - Country:US
Practice Address - Phone:207-786-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility