MEDICARE: PRESQUE ISLE HEALTHCARE CENTER 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

General Provider Information

NPI Number	:	1922993963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESQUE ISLE HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	100 WATERMAN DR STE 401
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2880
Country	:	US
Telephone Number	:	207-619-7942
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3180
Country	:	US
Telephone Number	:	207-619-7942
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WANDA J PELKEY
Credential	:
Telephone Number	:	207-939-1117

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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