Healthcare Provider Details

I. General information

NPI: 1669708988
Provider Name (Legal Business Name): PCAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 DEVONSHIRE ST
PORTLAND ME
04103-4431
US

IV. Provider business mailing address

68 DEVONSHIRE ST
PORTLAND ME
04103-4431
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-2893
  • Fax:
Mailing address:
  • Phone: 207-772-2893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number3668
License Number StateME

VIII. Authorized Official

Name: WANDA PELKEY
Title or Position: CFO
Credential: CPA
Phone: 207-874-2700