Healthcare Provider Details

I. General information

NPI: 1811882855
Provider Name (Legal Business Name): CARIBOU HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BERNADETTE ST
CARIBOU ME
04736-2038
US

IV. Provider business mailing address

100 WATERMAN DR STE 401
SOUTH PORTLAND ME
04106-2880
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-3102
  • Fax:
Mailing address:
  • Phone: 207-619-7942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: WANDA J PELKEY
Title or Position: CEO
Credential:
Phone: 207-619-7942