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General NPI Number Information
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NPI Number | 1962402990
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Entity Type | Organization
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Legal Business Name | CARIBOU NURSING HOME, INC.
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Dates
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Enumeration Date | 08/01/2005
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 10 BERNADETTE ST
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City | CARIBOU
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State | ME
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Zip | 04736-3908
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Country | US
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Telephone | 207-498-3102
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Fax | 207-498-3461
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Provider Business Mailing Address
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Address Line | 10 BERNADETTE ST
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City | CARIBOU
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State | ME
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Zip | 04736-3908
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Country | US
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Telephone | 207-498-3102
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Fax | 207-498-3461
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PHILIP A CYR
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Credential |
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Telephone | 207-498-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 37946
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 37946
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License Number State | ME
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