Provider Demographics
NPI:1245620103
Name:NORTH HAVEN ARCH SUPPORTS
Entity Type:Organization
Organization Name:NORTH HAVEN ARCH SUPPORTS
Other - Org Name:GOOD FEET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-677-0151
Mailing Address - Street 1:70 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3800
Mailing Address - Country:US
Mailing Address - Phone:860-677-0151
Mailing Address - Fax:
Practice Address - Street 1:70 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3800
Practice Address - Country:US
Practice Address - Phone:860-677-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier