Healthcare Provider Details

I. General information

NPI: 1447204763
Provider Name (Legal Business Name): MAINE COAST REGIONAL HEALTH FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION ST
ELLSWORTH ME
04605-1586
US

IV. Provider business mailing address

50 UNION ST
ELLSWORTH ME
04605-1586
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-5301
  • Fax: 207-664-5498
Mailing address:
  • Phone:
  • Fax: 207-664-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number36279
License Number StateME

VIII. Authorized Official

Name: MR. JOHN RONAN
Title or Position: PRESIDENT
Credential:
Phone: 207-664-5311