Provider Demographics
NPI:1336864966
Name:ANTONIO HOME CARE LLC
Entity Type:Organization
Organization Name:ANTONIO HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-482-9516
Mailing Address - Street 1:70 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2433
Mailing Address - Country:US
Mailing Address - Phone:207-482-9516
Mailing Address - Fax:
Practice Address - Street 1:70 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2433
Practice Address - Country:US
Practice Address - Phone:207-482-9516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care