Healthcare Provider Details

I. General information

NPI: 1780885806
Provider Name (Legal Business Name): DAVIS LONG TERM CARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 MAINE AVE
FARMINGDALE ME
04344-1526
US

IV. Provider business mailing address

58 PARK ST SUITE 202
ROCKLAND ME
04841-2862
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-7082
  • Fax: 207-512-2037
Mailing address:
  • Phone: 207-594-4985
  • Fax: 207-594-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALLS2118
License Number StateME

VIII. Authorized Official

Name: PAULA HOUST
Title or Position: CFO
Credential:
Phone: 207-594-4985