Provider Demographics
NPI:1174642177
Name:COLONIAL MEDICAL ASSISTED DEVICES
Entity Type:Organization
Organization Name:COLONIAL MEDICAL ASSISTED DEVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-881-8351
Mailing Address - Street 1:14 CELINA AVE
Mailing Address - Street 2:UNIT #1
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1025
Mailing Address - Country:US
Mailing Address - Phone:603-881-8351
Mailing Address - Fax:603-595-8019
Practice Address - Street 1:14 CELINA AVE
Practice Address - Street 2:UNIT #1
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1025
Practice Address - Country:US
Practice Address - Phone:603-881-8351
Practice Address - Fax:603-595-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227858Medicaid
IA0961037Medicaid
NH30004860Medicaid
MA1531956Medicaid