Individual
WILLY NDAGUSHIMAMANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 DUDLEY ST UNIT 2, HAMPDEN, ME 04444-1627
(402) 617-4211
Mailing address
10 DUDLEY ST UNIT 2, HAMPDEN, ME 04444-1627
(402) 617-4211
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
372600000X
Adult Companion
Primary
—
NE
Other
Enumeration date
08/29/2024
Last updated
10/07/2025
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