Healthcare Provider Details

I. General information

NPI: 1821713256
Provider Name (Legal Business Name): METANOIA COMPASSIONATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/26/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMARLANE UNIT 2
PORTLAND ME
04103-4240
US

IV. Provider business mailing address

2 TAMARLANE UNIT 2
PORTLAND ME
04103-4240
US

V. Phone/Fax

Practice location:
  • Phone: 207-352-8862
  • Fax:
Mailing address:
  • Phone: 207-352-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEAN LENGA LENDA
Title or Position: MANAGER
Credential:
Phone: 207-352-8862