Healthcare Provider Details

I. General information

NPI: 1649996158
Provider Name (Legal Business Name): AMANI CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 09/27/2023
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CUMBERLAND AVENUE UNIT 101
PORTLAND ME
04101
US

IV. Provider business mailing address

409 CUMBERLAND AVENUE UNIT 101
PORTLAND ME
04101
US

V. Phone/Fax

Practice location:
  • Phone: 207-352-8482
  • Fax:
Mailing address:
  • Phone: 207-352-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. NOUHOURI SEPE
Title or Position: MANAGING MEMBER
Credential:
Phone: 207-352-8482