Healthcare Provider Details

I. General information

NPI: 1245159490
Provider Name (Legal Business Name): COMPASSIONATE CARE RESPONSE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SULLIVAN ST
BERWICK ME
03901-3005
US

IV. Provider business mailing address

PO BOX 111
YORK ME
03909-0111
US

V. Phone/Fax

Practice location:
  • Phone: 207-337-5790
  • Fax: 207-337-5790
Mailing address:
  • Phone: 207-337-5790
  • Fax: 207-337-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TRESOR SELENGA KUMUGO
Title or Position: OWNER
Credential: CASE MANAGER
Phone: 207-337-5790