1326278748 NPI number — EDELWEISS FAMILY CARE & TELEHEALTH,LLC

Table of content: (NPI 1326278748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326278748 NPI number — EDELWEISS FAMILY CARE & TELEHEALTH,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDELWEISS FAMILY CARE & TELEHEALTH,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:
1326278748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ROUTE 236
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
KITTERY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03904-5528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-740-4550
Provider Business Mailing Address Fax Number:
603-740-4551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-3434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-740-4550
Provider Business Practice Location Address Fax Number:
603-740-4551
Provider Enumeration Date:
07/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ENZINGER
Authorized Official First Name:
EVA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
603-740-4550

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  11732 , 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)





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