Healthcare Provider Details

I. General information

NPI: 1962402990
Provider Name (Legal Business Name): CARIBOU NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BERNADETTE ST
CARIBOU ME
04736-3908
US

IV. Provider business mailing address

10 BERNADETTE ST
CARIBOU ME
04736-3908
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-3102
  • Fax: 207-498-3461
Mailing address:
  • Phone: 207-498-3102
  • Fax: 207-498-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number37946
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number37946
License Number StateME

VIII. Authorized Official

Name: MR. PHILIP A CYR
Title or Position: ADMINISTRATOR
Credential:
Phone: 207-498-3102