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General NPI Number Information
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NPI Number | 1184052243
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Entity Type | Organization
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Legal Business Name | DOVER-FOXCROFT HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/28/2013
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 1037 WEST MAIN STREET
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City | DOVER-FOXCROFT
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-564-8129
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Fax | 207-564-8484
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Provider Business Mailing Address
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Address Line | 100 WATERMAN DRIVE SUITE 401
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-874-2700
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Fax | 207-874-2706
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNIFER I CLARKE
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Credential |
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Telephone | 207-619-7942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 37812
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 37812
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 37812
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License Number State | ME
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