1215148069 NPI number — CHPG DBA CHOLESTEROL TREATMENT CENTER

Table of content: MS. CINDY GOMEZ LPC, LCDC (NPI 1992581300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215148069 NPI number — CHPG DBA CHOLESTEROL TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHPG DBA CHOLESTEROL TREATMENT CENTER
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:
1215148069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 PLEASANT ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-230-1920
Provider Business Mailing Address Fax Number:
603-230-1922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-2548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-230-1920
Provider Business Practice Location Address Fax Number:
603-230-1922
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FALKENHAM
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN SERVICES COORDINATOR
Authorized Official Telephone Number:
603-227-7140

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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