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General NPI Number Information
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NPI Number | 1982191300
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Entity Type | Organization
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Legal Business Name | SOUTHERN MAINE HOMECARE, LLC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 118 ANDERSON ST
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City | PORTLAND
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State | ME
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Zip | 04101-2546
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Country | US
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Telephone | 207-615-3103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3153
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City | PORTLAND
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State | ME
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Zip | 04104-3153
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Country | US
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Telephone | 207-615-3103
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ABDIAZIZ A MOHAMED
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Credential | ADMINSTRATOR
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Telephone | 207-615-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | ME
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