Sure Residential Care LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SURE RESIDENTIAL CARE LLC

Practice address

43 Shepherd LN
Portland, ME 04103-1674

Phone

(207) 618-2857

NPI assigned

Jun 20, 2021

Organization subpart

No

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

Authorized official

Name

Djuma Mbalassa, DSP

Title

Ceo

Phone

(207) 618-2857

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1624147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624147200000",
    "number": "1891364345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 SHEPHERD LN",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031674",
            "telephone_number": "207-618-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 SHEPHERD LN",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031674",
            "telephone_number": "207-618-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURE RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-20",
        "last_updated": "2021-06-20",
        "certification_date": "2021-06-20",
        "status": "A",
        "authorized_official_last_name": "MBALASSA",
        "authorized_official_first_name": "DJUMA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-618-2857",
        "authorized_official_credential": "DSP"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jonathan M Swartz, MD, MMSC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Portland, ME
• Providers in Portland, ME by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2021; 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.