Healthcare Provider Details

I. General information

NPI: 1063928695
Provider Name (Legal Business Name): SHEKINAH FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 AUBURN ST APT A4
PORTLAND ME
04103-2147
US

IV. Provider business mailing address

238 AUBURN ST APT A4
PORTLAND ME
04103-2147
US

V. Phone/Fax

Practice location:
  • Phone: 207-618-3784
  • Fax:
Mailing address:
  • Phone: 207-618-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. NARCISSE MUGISHA
Title or Position: OWNER
Credential:
Phone: 207-618-3784