Provider Demographics
NPI:1780306084
Name:AZEL RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:AZEL RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNYAMAHORO
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-409-4176
Mailing Address - Street 1:21 WALKER ST APT C
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2961
Mailing Address - Country:US
Mailing Address - Phone:207-409-4176
Mailing Address - Fax:
Practice Address - Street 1:21 WALKER ST APT C
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2961
Practice Address - Country:US
Practice Address - Phone:207-409-4176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities