Basic Information
| Provider Information | |||||||||
| NPI: | 1164080032 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED CARE HOUSE CALLS OF NEW HAMPSHIRE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED CARE HOUSE CALLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51266 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705051266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372331307 | ||||||||
| FaxNumber: | 3372335764 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 CALEF HWY UNIT 7 | ||||||||
| Address2: | |||||||||
| City: | EPPING | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030422367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036866204 | ||||||||
| FaxNumber: | 6033712432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | GACHASSIN | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3372331307 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.