Organization
ATLANTIC COMMUNITY SUPPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KAMIL AWEIS SUJA (CEO)
(207) 405-7181
Entity
Organization
Contact information
Practice address
75 BISHOP ST STE 13, PORTLAND, ME 04103-2614
(207) 405-7181
Mailing address
75 BISHOP ST STE 13, PORTLAND, ME 04103-2614
(207) 405-7181
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-3458034
—
ME
Enumeration date
10/24/2019
Last updated
10/24/2019
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