MEDICARE: SHEKINAH FAMILY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1215403589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEKINAH FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	238 AUBURN ST APT A4
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-2147
Country	:	US
Telephone Number	:	207-618-3784
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 CONSTITUTION DR STE 1A
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6002
Country	:	US
Telephone Number	:	207-618-3784
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NARCISSE MUGISHA
Credential	:
Telephone Number	:	207-618-3784

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	01/15/2019

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