Provider Demographics
NPI:1275305799
Name:CALMBROOK RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:CALMBROOK RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAREKEZI UMURERWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-766-8038
Mailing Address - Street 1:723 RIVERSIDE ST APT 531
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5941
Mailing Address - Country:US
Mailing Address - Phone:207-766-8038
Mailing Address - Fax:
Practice Address - Street 1:723 RIVERSIDE ST APT 531
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5941
Practice Address - Country:US
Practice Address - Phone:207-766-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities