1649222357 NPI number — VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY

Table of content: (NPI 1649222357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649222357 NPI number — VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY
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:
1649222357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 432
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CONWAY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03860-0432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-356-7006
Provider Business Mailing Address Fax Number:
603-356-8134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1529 WHITE MOUNTAIN HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CONWAY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03860-5355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-356-7006
Provider Business Practice Location Address Fax Number:
603-356-8134
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUKA
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
603-356-7006

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  02737 , 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: 80307020 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99591033 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 307020 . This is a "ANTHEM BCBS PROVIDER #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 307020 . This is a "PTAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".