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General NPI Number Information
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NPI Number | 1871560219
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Entity Type | Organization
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Legal Business Name | DAVIS LONG TERM CARE GROUP INC
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 462 ESSEX ST
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City | DOVER FOXCROFT
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State | ME
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Zip | 04426-1311
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Country | US
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Telephone | 207-564-3049
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Fax | 207-564-2019
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Provider Business Mailing Address
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Address Line | 58 PARK ST SUITE 202
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City | ROCKLAND
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State | ME
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Zip | 04841-2862
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Country | US
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Telephone | 207-594-4990
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Fax | 207-594-4974
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERNARD E DAVIS JR.
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Credential |
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Telephone | 207-594-4990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 113410004
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License Number State | ME
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