Provider Demographics
NPI:1417617135
Name:MAINE PARADISE HOMECARE, INC
Entity Type:Organization
Organization Name:MAINE PARADISE HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PKA
Authorized Official - Middle Name:KAMBA
Authorized Official - Last Name:FAUSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-525-2529
Mailing Address - Street 1:100 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3035
Mailing Address - Country:US
Mailing Address - Phone:646-525-2529
Mailing Address - Fax:
Practice Address - Street 1:100 LYMAN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3035
Practice Address - Country:US
Practice Address - Phone:646-525-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health