Provider Demographics
NPI:1598542896
Name:LOVING CARE RESIDENTIAL LLC
Entity Type:Organization
Organization Name:LOVING CARE RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWETE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-460-5898
Mailing Address - Street 1:15 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2521
Mailing Address - Country:US
Mailing Address - Phone:207-460-5898
Mailing Address - Fax:
Practice Address - Street 1:15 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2521
Practice Address - Country:US
Practice Address - Phone:207-460-5898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities