Provider Demographics
NPI:1104607449
Name:MAGO HOPE CARE LLC
Entity type:Organization
Organization Name:MAGO HOPE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:
Authorized Official - Last Name:NZIGIYIMANA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:347-904-1385
Mailing Address - Street 1:364 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2911
Mailing Address - Country:US
Mailing Address - Phone:347-904-1385
Mailing Address - Fax:
Practice Address - Street 1:364 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2911
Practice Address - Country:US
Practice Address - Phone:347-904-1385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities