Provider Demographics
NPI:1437616737
Name:EASY CARE RESIDENTIAL LLC
Entity Type:Organization
Organization Name:EASY CARE RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OCHOLA
Authorized Official - Last Name:OKENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-939-1009
Mailing Address - Street 1:38 AMHERST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2937
Mailing Address - Country:US
Mailing Address - Phone:207-939-1009
Mailing Address - Fax:
Practice Address - Street 1:38 AMHERST ST STE 1
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2937
Practice Address - Country:US
Practice Address - Phone:207-939-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care