Provider Demographics
NPI:1821834912
Name:MAINE COASTLINE SUPPORT LLC
Entity type:Organization
Organization Name:MAINE COASTLINE SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGARAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-441-6364
Mailing Address - Street 1:21 PIN OAK DR APT 2101
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8266
Mailing Address - Country:US
Mailing Address - Phone:469-441-6364
Mailing Address - Fax:
Practice Address - Street 1:21 PIN OAK DR APT 2101
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8266
Practice Address - Country:US
Practice Address - Phone:469-441-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINE COASTLINE SUPPORT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care