Provider Demographics
NPI:1063928695
Name:SHEKINAH FAMILY SERVICES
Entity type:Organization
Organization Name:SHEKINAH FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NARCISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGISHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-618-3784
Mailing Address - Street 1:238 AUBURN ST APT A4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2147
Mailing Address - Country:US
Mailing Address - Phone:207-618-3784
Mailing Address - Fax:
Practice Address - Street 1:238 AUBURN ST APT A4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2147
Practice Address - Country:US
Practice Address - Phone:207-618-3784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========Medicaid