Basic Information
Provider Information | |||||||||
NPI: | 1669512794 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SOLAMOR HOSPICE CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SOLAMOR HOSPICE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 170 SOUTH RIVER ROAD | ||||||||
Address2: | BUILDING 2 | ||||||||
City: | BEDFORD | ||||||||
State: | NH | ||||||||
PostalCode: | 031106941 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036067974 | ||||||||
FaxNumber: | 6036067988 | ||||||||
Practice Location | |||||||||
Address1: | 170 SOUTH RIVER ROAD | ||||||||
Address2: | BUILDING 2 | ||||||||
City: | BEDFORD | ||||||||
State: | NH | ||||||||
PostalCode: | 031106941 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036067974 | ||||||||
FaxNumber: | 6036067988 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/07/2007 | ||||||||
LastUpdateDate: | 08/27/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BERG | ||||||||
AuthorizedOfficialFirstName: | MICHAEL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 5054684752 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SOLAMOR HOPSICE CORPORATION | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X |   |   | N |   | Agencies | Hospice Care, Community Based |   | 251G00000X | 03256 | NH | Y |   | Agencies | Hospice Care, Community Based |   |
No ID Information.