Healthcare Provider Details

I. General information

NPI: 1326523366
Provider Name (Legal Business Name): AWARE RECOVERY CARE OF MAINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTHBOROUGH DR STE 500-202
SOUTH PORTLAND ME
04106-6928
US

IV. Provider business mailing address

35 THORPE AVE STE 104
WALLINGFORD CT
06492-1948
US

V. Phone/Fax

Practice location:
  • Phone: 203-779-5799
  • Fax:
Mailing address:
  • Phone: 203-779-5799
  • Fax: 203-421-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GEORGE MERHI
Title or Position: CFO
Credential:
Phone: 203-779-5799