Provider Demographics
NPI:1619688876
Name:AGING KINGDOM HOMECARE, LLC
Entity Type:Organization
Organization Name:AGING KINGDOM HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNIKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-494-0123
Mailing Address - Street 1:88 PARK AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2192
Mailing Address - Country:US
Mailing Address - Phone:207-494-0123
Mailing Address - Fax:
Practice Address - Street 1:415 CONGRESS ST STE 301U
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3586
Practice Address - Country:US
Practice Address - Phone:207-881-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care