MEDICARE: MAINE GENERAL HEALTH REHABILITATION & LONG TERM CARE

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	311500000X	Alzheimer Center (Dementia Center)	ALLS1962	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366592461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINE GENERAL HEALTH REHABILITATION & LONG TERM CARE

Provider Business Mailing Address
First Line	:	154 DRESDEN AVE
Second Line	:
City	:	GARDINER
State	:	ME
Zip	:	04345-2615
Country	:	US
Telephone Number	:	207-626-1770
Fax Number	:	207-626-1814

Provider Business Practice Location Address
First Line	:	154 DRESDEN AVE
Second Line	:
City	:	GARDINER
State	:	ME
Zip	:	04345-2615
Country	:	US
Telephone Number	:	207-626-1770
Fax Number	:	207-626-1814

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	GILLIAN FITZGERALD-CROSBY
Credential	:
Telephone Number	:	207-861-3488

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/27/2023

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