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General NPI Number Information
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NPI Number | 1700594355
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Entity Type | Organization
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Legal Business Name | MP LIVING CARE LLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 227 SEVENTH ST
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City | AUBURN
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State | ME
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Zip | 04210-6626
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Country | US
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Telephone | 347-740-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 227 SEVENTH ST
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City | AUBURN
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State | ME
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Zip | 04210-6626
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Country | US
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Telephone | 347-740-5264
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JOHNNY TSHIKULA ILUNGA
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Credential |
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Telephone | 134-774-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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