Healthcare Provider Details

I. General information

NPI: 1083008098
Provider Name (Legal Business Name): MAINE LIFE CARE RETIREMENT COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PIPER ROAD
SCARBOROUGH ME
04074-7541
US

IV. Provider business mailing address

PO BOX 1778
LEWISTON ME
04241-1778
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-8700
  • Fax:
Mailing address:
  • Phone: 207-375-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ASHLEY
Title or Position: MANAGER
Credential:
Phone: 207-799-0866