1174785414 NPI number — TC HEALTHCARE I, LLC

Table of content: MS. MICHELE VIVIENE BUNKER-ALBERTS MSN, FNP, IBCLC (NPI 1295730935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174785414 NPI number — TC HEALTHCARE I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TC HEALTHCARE I, 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:
CHELSEA HEALTH CARE FACILITY
Provider Other Organization Name Type Code:
3
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:
1174785414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
86 JUNIPER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06033-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-930-0091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02150-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-889-2250
Provider Business Practice Location Address Fax Number:
617-889-0105
Provider Enumeration Date:
06/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COBURN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
860-930-0091

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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