Provider Demographics
NPI:1962542092
Name:ALLEGIANCE HOSPICE CARE OF MAINE
Entity type:Organization
Organization Name:ALLEGIANCE HOSPICE CARE OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-996-5900
Mailing Address - Street 1:101 SUN AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-0000
Mailing Address - Country:US
Mailing Address - Phone:505-468-5604
Mailing Address - Fax:505-468-4681
Practice Address - Street 1:100 FODEN ROAD WEST
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2323
Practice Address - Country:US
Practice Address - Phone:207-761-6967
Practice Address - Fax:207-772-6240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGIANCE HOSPICE GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37044251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432631300Medicaid
ME201519Medicare Oscar/Certification