1376872242 NPI number — PARENTCOACH FAMILY COUNSELING, LLC

Table of content: (NPI 1376872242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376872242 NPI number — PARENTCOACH FAMILY COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARENTCOACH FAMILY COUNSELING, 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:
1376872242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 TECHNOLOGY WAY
Provider Second Line Business Mailing Address:
SUITE 3W7
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-595-9355
Provider Business Mailing Address Fax Number:
866-579-5833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 TECHNOLOGY WAY
Provider Second Line Business Practice Location Address:
SUITE 3W7
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-595-9355
Provider Business Practice Location Address Fax Number:
866-579-5833
Provider Enumeration Date:
12/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CURRIER
Authorized Official First Name:
JUDE
Authorized Official Middle Name:
THADDEUS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-595-9355

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1188 , 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: 30422765 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: RE7689 . This is a "MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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