Provider Demographics
NPI:1356080519
Name:REAL CARE MAINE LLC
Entity type:Organization
Organization Name:REAL CARE MAINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NZEYIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-615-7794
Mailing Address - Street 1:21 SCHOOL ST APT 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3939
Mailing Address - Country:US
Mailing Address - Phone:207-615-7794
Mailing Address - Fax:
Practice Address - Street 1:21 SCHOOL ST APT 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3939
Practice Address - Country:US
Practice Address - Phone:207-615-7794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities