Provider Demographics
NPI:1306656020
Name:ST MICHAEL THE ARCHANGEL COMMUNITY LIVING LLC
Entity type:Organization
Organization Name:ST MICHAEL THE ARCHANGEL COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MANISHIMWE K
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-858-4014
Mailing Address - Street 1:166 WELLINGTON TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4006
Mailing Address - Country:US
Mailing Address - Phone:617-858-4014
Mailing Address - Fax:
Practice Address - Street 1:166 WELLINGTON TERRACE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4006
Practice Address - Country:US
Practice Address - Phone:617-858-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health