Provider Demographics
NPI:1154060572
Name:PRIME CARE MAINE LLC
Entity Type:Organization
Organization Name:PRIME CARE MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNEZERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-314-7012
Mailing Address - Street 1:641 N AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8716
Mailing Address - Country:US
Mailing Address - Phone:207-314-7012
Mailing Address - Fax:
Practice Address - Street 1:641 N AUBURN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8716
Practice Address - Country:US
Practice Address - Phone:207-314-7012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities