Organization
PINE PEAK CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANASSE SHINGIRO CRMA (MANAGING MEMBER)
(207) 415-6894
Entity
Organization
Contact information
Practice address
1395 CONGRESS ST, PORTLAND, ME 04102-2120
(207) 415-6894
Mailing address
13 SARA LN, PORTLAND, ME 04103-3622
(207) 415-6894
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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