Organization
WYATT RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AXEL NIMBONA (CEO)
(207) 409-0334
Entity
Organization
Contact information
Practice address
78 FOXCROFT DR, SCARBOROUGH, ME 04074-8734
(207) 409-0334
Mailing address
78 FOXCROFT DR, SCARBOROUGH, ME 04074-8734
(207) 409-0334
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/09/2025
Last updated
06/09/2025
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