Provider Demographics
NPI:1073663340
Name:TOWN OF MOULTONBOROUGH
Entity Type:Organization
Organization Name:TOWN OF MOULTONBOROUGH
Other - Org Name:MOULTONBOROUGH VISITING NURSE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:PEASLEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-476-2350
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:6 HOLLAND ST
Mailing Address - City:MOULTONBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03254-0138
Mailing Address - Country:US
Mailing Address - Phone:603-476-2350
Mailing Address - Fax:603-476-5811
Practice Address - Street 1:6 HOLLAND STREET
Practice Address - Street 2:
Practice Address - City:MOULTONBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03254
Practice Address - Country:US
Practice Address - Phone:603-476-2350
Practice Address - Fax:603-476-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01372251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH307067Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER