Provider Demographics
NPI:1942991351
Name:RAISE UP HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:RAISE UP HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OTHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-239-9656
Mailing Address - Street 1:535 OCEAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4970
Mailing Address - Country:US
Mailing Address - Phone:207-239-9656
Mailing Address - Fax:
Practice Address - Street 1:535 OCEAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4970
Practice Address - Country:US
Practice Address - Phone:207-239-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care