Provider Demographics
NPI:1336849421
Name:DOVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:DOVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YANNICK
Authorized Official - Middle Name:NOAH
Authorized Official - Last Name:IRADUKUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-352-8803
Mailing Address - Street 1:20 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2750
Mailing Address - Country:US
Mailing Address - Phone:207-352-8803
Mailing Address - Fax:
Practice Address - Street 1:20 GREEN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2750
Practice Address - Country:US
Practice Address - Phone:207-352-8803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities