Green Leaf Residential Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

GREEN LEAF RESIDENTIAL CARE LLC

Practice address

24 Wellesley Ests
Portland, ME 04103-1170

Phone

(207) 615-4036

NPI assigned

Jul 29, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Antoine Rubenga Bikamba

Title

Managing Director

Phone

(207) 615-4036

Specialties & licenses 1

Addresses

Electronic endpoints 4

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564358400000",
    "number": "1366096323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 WELLESLEY ESTS",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031170",
            "telephone_number": "207-615-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 WELLESLEY ESTS",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031170",
            "telephone_number": "207-615-4036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LEAF RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-29",
        "last_updated": "2019-07-29",
        "status": "A",
        "authorized_official_last_name": "BIKAMBA",
        "authorized_official_first_name": "ANTOINE",
        "authorized_official_middle_name": "RUBENGA",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "207-615-4036",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Portland",
            "affiliation": "N",
            "address_1": "24 Wellesley Ests",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041031170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Portland",
            "affiliation": "N",
            "address_1": "24 Wellesley Ests",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041031170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Portland",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Portland",
            "address_1": "24 Wellesley Ests",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041031170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Portland",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "24 Wellesley Ests",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041031170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David R Greatorex, M.D.
• Patricia Greatorex, M.D.
• Jennifer Warren Greaves, L.C.S.W., L.A.D.C.
• Callie Wells Greco, MD
• Edward Scott Greeley II, D.P.T.
• Cassie M Green, PSYD
• Donald James Green
• John William Green, LCSW
• Matthew A. Green, MD
• Patrick Green, ATC

• In Home Supportive Care Agency in Portland, ME
• Providers in Portland, ME by specialty
• In Home Supportive Care Agency in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2019; 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.