1558141564 NPI number — FAMILY COMMUNITY CARE LLC

Table of content: JULIE ANNE KERWOOD MS (NPI 1013906106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558141564 NPI number — FAMILY COMMUNITY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY COMMUNITY CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558141564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
696 WESTBROOK ST APT 4G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-1969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-285-3740
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
696 WESTBROOK ST APT 4G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-1969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-285-3740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BITTOCK
Authorized Official First Name:
MODEST
Authorized Official Middle Name:
MANASE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
859-285-3740

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)