Healthcare Provider Details

I. General information

NPI: 1467204859
Provider Name (Legal Business Name): UBUZIMA RESIDENTAIL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 EAST AVE
LEWISTON ME
04240-5513
US

IV. Provider business mailing address

183 EAST AVE
LEWISTON ME
04240-5513
US

V. Phone/Fax

Practice location:
  • Phone: 512-619-9872
  • Fax:
Mailing address:
  • Phone: 512-619-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: UMUTONI ALICE I
Title or Position: CEO
Credential:
Phone: 512-619-9872