Healthcare Provider Details

I. General information

NPI: 1619869286
Provider Name (Legal Business Name): AUTHENTIC VIBES HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LOLA DR
SOUTH CHINA ME
04358-3048
US

IV. Provider business mailing address

25 LOLA DR
SOUTH CHINA ME
04358-3048
US

V. Phone/Fax

Practice location:
  • Phone: 207-313-6051
  • Fax:
Mailing address:
  • Phone: 207-313-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY LAKE
Title or Position: OWNER
Credential:
Phone: 207-313-6051