Healthcare Provider Details

I. General information

NPI: 1295553006
Provider Name (Legal Business Name): CONFORT COMMUNITY LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 LIBERTY LN UNIT 97
SOUTH PORTLAND ME
04106-3957
US

IV. Provider business mailing address

39 LIBERTY LN UNIT 97
SOUTH PORTLAND ME
04106-3957
US

V. Phone/Fax

Practice location:
  • Phone: 512-767-9092
  • Fax:
Mailing address:
  • Phone: 512-767-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT RUREMESHA SR.
Title or Position: CEO
Credential:
Phone: 512-767-9092