Great Residential Home Care LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

GREAT RESIDENTIAL HOME CARE LLC

Practice address

238 Auburn St Apt D37
Portland, ME 04103-2150

Phone

(207) 518-1535

NPI assigned

Dec 12, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph Bizimana, DSP

Title

Ceo

Phone

(207) 518-1535

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607731200000",
    "number": "1295321487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 AUBURN ST APT D37",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032150",
            "telephone_number": "207-518-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 AUBURN ST APT D37",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032150",
            "telephone_number": "207-518-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RESIDENTIAL HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-12",
        "last_updated": "2020-12-12",
        "certification_date": "2020-12-12",
        "status": "A",
        "authorized_official_last_name": "BIZIMANA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-518-1535",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DSP"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "PORTLAND",
            "affiliation": "N",
            "address_1": "238 Auburn St Apt D37",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041032150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.