Provider Demographics
NPI:1326510595
Name:APEX RESIDENTIAL SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:APEX RESIDENTIAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THIERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-615-3328
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0876
Mailing Address - Country:US
Mailing Address - Phone:207-841-9004
Mailing Address - Fax:
Practice Address - Street 1:196 MEADOW CROSS RD
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086
Practice Address - Country:US
Practice Address - Phone:207-841-9004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities