Provider Demographics
NPI:1790465888
Name:INTARE HEALTHCARE SYSTEMS LLC
Entity Type:Organization
Organization Name:INTARE HEALTHCARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PACIFIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRADUKUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-423-5362
Mailing Address - Street 1:190 ELM ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2394
Mailing Address - Country:US
Mailing Address - Phone:207-423-5362
Mailing Address - Fax:
Practice Address - Street 1:190 ELM ST APT 2
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2394
Practice Address - Country:US
Practice Address - Phone:207-423-5362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities