MEDICARE: ELRCARE MAINE LLC

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	314000000X	Skilled Nursing Facility	2407	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	:	1598762056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELRCARE MAINE LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 15
Second Line	:	15 MAIN STREET
City	:	PENOBSCOT
State	:	ME
Zip	:	04476-0015
Country	:	US
Telephone Number	:	207-326-4344
Fax Number	:	207-326-9615

Provider Business Practice Location Address
First Line	:	15 MAIN STREET
Second Line	:
City	:	PENOBSCOT
State	:	ME
Zip	:	04476-0015
Country	:	US
Telephone Number	:	207-326-4344
Fax Number	:	207-326-9615

Authorized Official
Title or Position	:	RECEIVER
Name	:	MR. MICHAEL TYLER
Credential	:
Telephone Number	:	207-854-2973

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/04/2012

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Directions to “ELRCARE MAINE LLC ” Practice Location

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