Provider Demographics
NPI:1265939748
Name:ACT RESIDENTIAL CARE
Entity type:Organization
Organization Name:ACT RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KABATA NGAYKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-409-2638
Mailing Address - Street 1:63 FREDERIC ST APT 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2762
Mailing Address - Country:US
Mailing Address - Phone:207-409-2638
Mailing Address - Fax:
Practice Address - Street 1:63 FREDERIC ST APT 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2762
Practice Address - Country:US
Practice Address - Phone:207-409-2638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care