Organization
HOME CARE RESIDENTIAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARD BIZIMANA (DIRECTOR)
(202) 413-2649
Entity
Organization
Contact information
Practice address
58 BOYD ST APT 501, PORTLAND, ME 04101-7127
(202) 413-2649
Mailing address
58 BOYD ST APT 501, PORTLAND, ME 04101-7127
(202) 413-2649
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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