Organization
COVENANT RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZABRON NDIKUMUKIZA (MANAGING DIRECTOR)
(207) 252-8470
Entity
Organization
Contact information
Practice address
696 WESTBROOK ST APT 13A, SOUTH PORTLAND, ME 04106-1987
(207) 252-8470
Mailing address
696 WESTBROOK ST APT 13A, SOUTH PORTLAND, ME 04106-1987
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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