Provider Demographics
NPI:1669172581
Name:NEW VESSEL LLC
Entity type:Organization
Organization Name:NEW VESSEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESIRE
Authorized Official - Middle Name:MUNYAKURI
Authorized Official - Last Name:NZABIRINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-409-0696
Mailing Address - Street 1:13 EMERSON ST APT 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 EMERSON ST APT 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3263
Practice Address - Country:US
Practice Address - Phone:207-409-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities