Organization
OUTFRONT JB FAMILY RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNBOOSCO OBOMA (OWNER)
(848) 214-0024
Entity
Organization
Contact information
Practice address
41 FRONT ST, PORTLAND, ME 04103-4951
(848) 214-0024
Mailing address
41 FRONT ST, PORTLAND, ME 04103-4951
(848) 214-0024
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/31/2018
Last updated
03/31/2018
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