Provider Demographics
NPI:1700122009
Name:MAINE RESIDENTIAL CARE GROUP
Entity Type:Organization
Organization Name:MAINE RESIDENTIAL CARE GROUP
Other - Org Name:SABATTUS RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANBAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-733-5159
Mailing Address - Street 1:69 LISBON RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4209
Mailing Address - Country:US
Mailing Address - Phone:207-375-6562
Mailing Address - Fax:207-375-6585
Practice Address - Street 1:189 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5159
Practice Address - Country:US
Practice Address - Phone:617-733-5159
Practice Address - Fax:508-583-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS5056310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility