Provider Demographics
NPI:1093369472
Name:COLMAN LIFE BREAKTHROUGH LLC
Entity Type:Organization
Organization Name:COLMAN LIFE BREAKTHROUGH LLC
Other - Org Name:COLMAN LIFE BREAKTHROUGH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INDEPENDENT NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LERREA
Authorized Official - Middle Name:MADELEINE
Authorized Official - Last Name:MENGATA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:857-249-8804
Mailing Address - Street 1:227 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2809
Mailing Address - Country:US
Mailing Address - Phone:857-249-8804
Mailing Address - Fax:
Practice Address - Street 1:227 FOSTER RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2809
Practice Address - Country:US
Practice Address - Phone:857-249-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLMAN LIFE BREAKTHROUGH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty