Provider Demographics
NPI:1275536575
Name:NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, INC.
Entity Type:Organization
Organization Name:NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, INC.
Other - Org Name:NORTH COUNTRY HOME HEALTH AGENCY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-444-5317
Mailing Address - Street 1:536 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4120
Mailing Address - Country:US
Mailing Address - Phone:603-444-5317
Mailing Address - Fax:603-444-0980
Practice Address - Street 1:536 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4120
Practice Address - Country:US
Practice Address - Phone:603-444-5317
Practice Address - Fax:603-444-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02236251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH9959-1017OtherMEDICAID HCBC
NH80307009Medicaid
30-1518OtherMEDICARE HOSPICE
NH9959-1017OtherMEDICAID HCBC
NH80307009Medicaid