Provider Demographics
NPI:1467204859
Name:UBUZIMA RESIDENTAIL CARE
Entity Type:Organization
Organization Name:UBUZIMA RESIDENTAIL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UMUTONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:512-619-9872
Mailing Address - Street 1:183 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5513
Mailing Address - Country:US
Mailing Address - Phone:512-619-9872
Mailing Address - Fax:
Practice Address - Street 1:183 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5513
Practice Address - Country:US
Practice Address - Phone:512-619-9872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities