MEDICARE: DAVIS LONG TERM CARE GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	113500000	ME

General Provider Information

NPI Number	:	1013984459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS LONG TERM CARE GROUP INC

Provider Business Mailing Address
First Line	:	58 PARK ST
Second Line	:	SUITE 202
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2862
Country	:	US
Telephone Number	:	207-594-4990
Fax Number	:	207-594-4974

Provider Business Practice Location Address
First Line	:	6 CHURCH ST
Second Line	:
City	:	LIMESTONE
State	:	ME
Zip	:	04750-1338
Country	:	US
Telephone Number	:	207-325-4771
Fax Number	:	207-325-4239

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BERNARD E DAVIS JR.
Credential	:
Telephone Number	:	207-594-4990

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/13/2009

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