1164592085 NPI number — INTERIM HEALTHCARE OF THE NEAST, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164592085 NPI number — INTERIM HEALTHCARE OF THE NEAST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF THE NEAST, 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:
INTERIM HEALTHCARE
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:
1164592085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 CHESTNUT ST
Provider Second Line Business Mailing Address:
P O BOX 1780
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03104-1780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-6956
Provider Business Mailing Address Fax Number:
603-668-6959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03104-1780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-668-6956
Provider Business Practice Location Address Fax Number:
603-668-6959
Provider Enumeration Date:
11/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLIER
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
603-668-6956

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  01973 , 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: 80307049 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99591010 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609986 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".