Provider Demographics
NPI:1447956909
Name:DEGMO HOME CARE LLC
Entity type:Organization
Organization Name:DEGMO HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHOUKRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-344-4597
Mailing Address - Street 1:124 LISBON ST # 3I
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7106
Mailing Address - Country:US
Mailing Address - Phone:207-344-4597
Mailing Address - Fax:
Practice Address - Street 1:124 LISBON ST # 3I
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7106
Practice Address - Country:US
Practice Address - Phone:207-344-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care