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Organization

HAVENRISE RESIDENTIAL CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ELCY ISHIMWE (CEO)
(857) 346-3798
Entity
Organization

Contact information

Practice address
605 STEVENS AVE APT 118, PORTLAND, ME 04103-2868
(857) 346-3798
Mailing address
605 STEVENS AVE APT 118, PORTLAND, ME 04103-2868
(857) 346-3798

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
02/17/2025
Last updated
02/17/2025
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