Provider Demographics
NPI:1588448534
Name:BIZUMUREMYI, MANOACH
Entity type:Individual
Prefix:
First Name:MANOACH
Middle Name:
Last Name:BIZUMUREMYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 364, 499 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-888-7646
Mailing Address - Fax:
Practice Address - Street 1:92 COLUMBIA ST APT 301
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6338
Practice Address - Country:US
Practice Address - Phone:207-888-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care