Provider Demographics
NPI:1679166482
Name:LIVINGSTONE COMMUNITY HEALTH CARE & SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:LIVINGSTONE COMMUNITY HEALTH CARE & SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NTIYANKUNDIYE
Authorized Official - Middle Name:
Authorized Official - Last Name:NTIYANKUNDIYE
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-332-0119
Mailing Address - Street 1:10 RED OAK DR APT 2D
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2092
Mailing Address - Country:US
Mailing Address - Phone:207-332-0119
Mailing Address - Fax:
Practice Address - Street 1:10 RED OAK DR APT 2D
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2092
Practice Address - Country:US
Practice Address - Phone:207-332-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health