Provider Demographics
NPI:1336632991
Name:MANZO CORPORATION
Entity Type:Organization
Organization Name:MANZO CORPORATION
Other - Org Name:AUTUMN OF LIFE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-949-6435
Mailing Address - Street 1:41 ACME RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1543
Mailing Address - Country:US
Mailing Address - Phone:207-217-6026
Mailing Address - Fax:207-217-6028
Practice Address - Street 1:41 ACME RD STE 1
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1543
Practice Address - Country:US
Practice Address - Phone:207-217-6026
Practice Address - Fax:207-217-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care