MEDICARE: NORTH COUNTRY ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	2035	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038426	OTHER	ME	BLUE CROSS PROVIDER #

General Provider Information

NPI Number	:	1043370273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COUNTRY ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	179 LISBON ST
Second Line	:	2ND FLOOR
City	:	LEWISTON
State	:	ME
Zip	:	04240-7248
Country	:	US
Telephone Number	:	207-786-3554
Fax Number	:	207-786-8507

Provider Business Practice Location Address
First Line	:	221 FAIRBANKS RD
Second Line	:
City	:	FARMINGTON
State	:	ME
Zip	:	04938-5723
Country	:	US
Telephone Number	:	207-778-3386
Fax Number	:	207-778-5869

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MR. GLEN G CYR
Credential	:
Telephone Number	:	207-786-3554

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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