Provider Demographics
NPI:1205515871
Name:EMBARK PLACE LLC
Entity type:Organization
Organization Name:EMBARK PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-630-3060
Mailing Address - Street 1:268 STATE STREET
Mailing Address - Street 2:2-7
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5417
Mailing Address - Country:US
Mailing Address - Phone:207-806-2021
Mailing Address - Fax:
Practice Address - Street 1:268 STATE STREET
Practice Address - Street 2:2-7
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5417
Practice Address - Country:US
Practice Address - Phone:207-806-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care