Provider Demographics
NPI:1265033088
Name:PALMS RESIDENTIAL CARE
Entity Type:Organization
Organization Name:PALMS RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:KIFOKIE
Authorized Official - Last Name:MULONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-620-8376
Mailing Address - Street 1:1500 FOREST AVE APT 13D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1846
Mailing Address - Country:US
Mailing Address - Phone:978-620-8376
Mailing Address - Fax:
Practice Address - Street 1:1500 FOREST AVE APT 13D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1846
Practice Address - Country:US
Practice Address - Phone:978-620-8376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities