Healthcare Provider Details

I. General information

NPI: 1851205215
Provider Name (Legal Business Name): CONQER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 WARREN AVE UNIT 1
LEWISTON ME
04240-4836
US

IV. Provider business mailing address

172 WARREN AVE
LEWISTON ME
04240-4836
US

V. Phone/Fax

Practice location:
  • Phone: 207-713-0263
  • Fax:
Mailing address:
  • Phone:
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: CONSTANTIN JITARU
Title or Position: CEO
Credential:
Phone: 207-713-0263