Provider Demographics
NPI:1154139830
Name:DYNAMIC RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:DYNAMIC RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DUMBA
Authorized Official - Last Name:BULENGA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:207-518-3592
Mailing Address - Street 1:19 PIN OAK DR APT 1906
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8264
Mailing Address - Country:US
Mailing Address - Phone:207-518-3592
Mailing Address - Fax:
Practice Address - Street 1:19 PIN OAK DR APT 1906
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8264
Practice Address - Country:US
Practice Address - Phone:207-518-3592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities