Organization
GREEN LEAF RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTOINE RUBENGA BIKAMBA (MANAGING DIRECTOR)
(207) 615-4036
Entity
Organization
Contact information
Practice address
24 WELLESLEY ESTS, PORTLAND, ME 04103-1170
(207) 615-4036
Mailing address
24 WELLESLEY ESTS, PORTLAND, ME 04103-1170
(207) 615-4036
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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