Provider Demographics
NPI:1467067496
Name:GENEROSITY RESIDENTIAL SERVICE LLC
Entity Type:Organization
Organization Name:GENEROSITY RESIDENTIAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-849-4078
Mailing Address - Street 1:418 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6024
Mailing Address - Country:US
Mailing Address - Phone:207-440-9902
Mailing Address - Fax:
Practice Address - Street 1:418 TURNER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6024
Practice Address - Country:US
Practice Address - Phone:207-440-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health