Provider Demographics
NPI:1194364083
Name:CRANMORE HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:CRANMORE HEALTH PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, FNP
Authorized Official - Phone:603-387-4523
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-0125
Mailing Address - Country:US
Mailing Address - Phone:603-387-4523
Mailing Address - Fax:603-369-4658
Practice Address - Street 1:1857 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-0381
Practice Address - Country:US
Practice Address - Phone:603-387-4523
Practice Address - Fax:603-369-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty