Basic Information
| Provider Information | |||||||||
| NPI: | 1992921472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE TRAINING ROOM, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 611 | ||||||||
| Address2: | |||||||||
| City: | HAMPSTEAD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210740611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103744000 | ||||||||
| FaxNumber: | 4103745000 | ||||||||
| Practice Location | |||||||||
| Address1: | 580 COURT ST | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033545454 | ||||||||
| FaxNumber: | 6033545483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 04/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | MICHIE KOONTZ | ||||||||
| AuthorizedOfficialFirstName: | TRISH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4103744000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 573631 | NH | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 30765167 | 05 | NH | MEDICAID |