1780826529 NPI number — PURE BALANCE HOLISTIC HEALING LLC

Table of content: (NPI 1780826529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780826529 NPI number — PURE BALANCE HOLISTIC HEALING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURE BALANCE HOLISTIC HEALING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780826529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 FRONT ST STE 408
Provider Second Line Business Mailing Address:
PO BOX 492
Provider Business Mailing Address City Name:
ROLLINSFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03869-7001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-387-3347
Provider Business Mailing Address Fax Number:
603-343-4708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 FRONT ST STE 408
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROLLINSFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03869-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-387-3347
Provider Business Practice Location Address Fax Number:
603-343-4708
Provider Enumeration Date:
03/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COUTURE
Authorized Official First Name:
KRYSTAL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICAL THERAPIST, OWNER
Authorized Official Telephone Number:
603-387-3347

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  3158 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1942301965 . This is a "NPI INDIVIDUAL PROVIDER IDENTIFIER" identifier . This identifiers is of the category "OTHER".




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