Provider Demographics
NPI:1134998966
Name:MAVERICK COMMUNITY CARE LLC
Entity type:Organization
Organization Name:MAVERICK COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FINNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:IRASHITSA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:207-409-8544
Mailing Address - Street 1:7 COBALT CT
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4691
Mailing Address - Country:US
Mailing Address - Phone:207-523-0091
Mailing Address - Fax:
Practice Address - Street 1:7 COBALT CT
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4691
Practice Address - Country:US
Practice Address - Phone:207-523-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities