Provider Demographics
NPI:1144529421
Name:HOMECARE BY PAULETT
Entity type:Organization
Organization Name:HOMECARE BY PAULETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-668-6122
Mailing Address - Street 1:696 WESTBROOK ST
Mailing Address - Street 2:APT 3I
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:134-766-8612
Mailing Address - Fax:
Practice Address - Street 1:696 WESTBROOK ST
Practice Address - Street 2:APT 3I
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1957
Practice Address - Country:US
Practice Address - Phone:134-766-8612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENONE251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care