Provider Demographics
NPI:1538911904
Name:HALO HOMECARE LLC
Entity type:Organization
Organization Name:HALO HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-400-5188
Mailing Address - Street 1:PO BOX 1862
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-1862
Mailing Address - Country:US
Mailing Address - Phone:207-400-5188
Mailing Address - Fax:
Practice Address - Street 1:54 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1121
Practice Address - Country:US
Practice Address - Phone:207-400-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities