Provider Demographics
NPI:1881452829
Name:MAISHA GROUP LLC
Entity type:Organization
Organization Name:MAISHA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGWANEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-858-7872
Mailing Address - Street 1:31 ROLLINS WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1942
Mailing Address - Country:US
Mailing Address - Phone:603-858-7872
Mailing Address - Fax:
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5448
Practice Address - Country:US
Practice Address - Phone:603-858-7872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty