Provider Demographics
NPI:1043086812
Name:LISUNGI GROUP HOME LLC
Entity Type:Organization
Organization Name:LISUNGI GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-409-8837
Mailing Address - Street 1:18 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3013
Mailing Address - Country:US
Mailing Address - Phone:207-409-8837
Mailing Address - Fax:
Practice Address - Street 1:18 EVERETT ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3013
Practice Address - Country:US
Practice Address - Phone:207-409-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities