1720136971 NPI number — LIFESHARE MANAGEMENT GROUP, INC.

Table of content: (NPI 1720136971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720136971 NPI number — LIFESHARE MANAGEMENT GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFESHARE MANAGEMENT GROUP, INC.
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:
1720136971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 ROGERS ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03103-5070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-625-8825
Provider Business Mailing Address Fax Number:
603-625-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 ROGERS ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-625-8825
Provider Business Practice Location Address Fax Number:
603-625-8875
Provider Enumeration Date:
01/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOUCETTE
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
CAROLINE
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
863-868-1607

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 691380698 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92115 . This is a "NH DCYF" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 003112847A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003112847C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 601100761 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30852455 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30854701 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3086307 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: LS72653 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000646400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410790000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410790100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 691380696 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92116 . This is a "NH DCYF" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 140BHS , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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