Provider Demographics
NPI:1700307469
Name:NEIGHBORHOOD RESIDENTIAL INC.
Entity Type:Organization
Organization Name:NEIGHBORHOOD RESIDENTIAL INC.
Other - Org Name:NEIGHBORHOOD RESIDENTIAL INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:KEKA
Authorized Official - Last Name:MUBANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:207-263-4783
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0072
Mailing Address - Country:US
Mailing Address - Phone:207-263-4783
Mailing Address - Fax:
Practice Address - Street 1:36 HADLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654-5108
Practice Address - Country:US
Practice Address - Phone:207-263-4783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERCC38637364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty