Healthcare Provider Details

I. General information

NPI: 1346605896
Provider Name (Legal Business Name): DLTC HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 MAINE AVE
FARMINGDALE ME
04344-1526
US

IV. Provider business mailing address

18 TALBOT AVE
ROCKLAND ME
04841-2959
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-7082
  • Fax:
Mailing address:
  • Phone: 207-594-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAD CLOUTIER
Title or Position: MANAGING MEMBER
Credential:
Phone: 207-594-4990