Provider Demographics
NPI:1619688876
Name:AGING KINGDOM HOMECARE
Entity type:Organization
Organization Name:AGING KINGDOM HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-494-0123
Mailing Address - Street 1:411 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3505
Mailing Address - Country:US
Mailing Address - Phone:207-494-0123
Mailing Address - Fax:
Practice Address - Street 1:415 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3500
Practice Address - Country:US
Practice Address - Phone:207-881-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty