1801972575 NPI number — THERACARE, LLC

Table of content: (NPI 1801972575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801972575 NPI number — THERACARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERACARE, 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:
THERACARE
Provider Other Organization Name Type Code:
4
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:
1801972575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 WASHINGTON PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-644-5900
Provider Business Mailing Address Fax Number:
603-644-5902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WASHINGTON PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-644-5900
Provider Business Practice Location Address Fax Number:
603-644-5902
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAVIGNE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
603-644-5900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30397622 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA51080 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com