Healthcare Provider Details

I. General information

NPI: 1275777880
Provider Name (Legal Business Name): MAINE GENERAL HEALTH REHABILITATION & LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 DRESDEN AVE
GARDINER ME
04345-2615
US

IV. Provider business mailing address

154 DRESDEN AVE
GARDINER ME
04345-2615
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1770
  • Fax: 207-626-1814
Mailing address:
  • Phone: 207-626-1770
  • Fax: 207-626-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberALLS3197
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: GILLIAN FITZGERALD-CROSBY
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 207-621-3781