Healthcare Provider Details

I. General information

NPI: 1194675876
Provider Name (Legal Business Name): CONSTANTIN JITARU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CONQER LLC

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 WARREN AVE UNIT 1
LEWISTON ME
04240-4836
US

IV. Provider business mailing address

770 ROOSEVELT TRL STE 8
N WINDHAM ME
04062-5300
US

V. Phone/Fax

Practice location:
  • Phone: 617-863-0161
  • Fax:
Mailing address:
  • Phone: 207-713-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: