Provider Demographics
NPI:1447939137
Name:ACADIA RESIDENTIAL CARE.LLC
Entity type:Organization
Organization Name:ACADIA RESIDENTIAL CARE.LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASIM
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BWANAKWELI
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:857-400-1386
Mailing Address - Street 1:15 BOWER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4721
Mailing Address - Country:US
Mailing Address - Phone:185-740-0138
Mailing Address - Fax:
Practice Address - Street 1:15 BOWER ST APT 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4721
Practice Address - Country:US
Practice Address - Phone:185-740-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities