Organization
68 DEVONSHIRE STREET
Active
Other names
Portland Center for Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA PELKEY (CFO)
(207) 874-2700
Entity
Organization
Contact information
Practice address
68 DEVONSHIRE ST, PORTLAND, ME 04103-4431
(207) 772-2893
Mailing address
68 DEVONSHIRE ST, PORTLAND, ME 04103-4431
(207) 772-2893
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
2011
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131950001
—
ME
Enumeration date
05/19/2009
Last updated
05/19/2009
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