Provider Demographics
NPI:1366634776
Name:LIFE LONG CARE OF NEW LONDON PLLC
Entity Type:Organization
Organization Name:LIFE LONG CARE OF NEW LONDON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FALICON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-526-4144
Mailing Address - Street 1:276 NEWPORT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5468
Mailing Address - Country:US
Mailing Address - Phone:603-526-4144
Mailing Address - Fax:603-526-4167
Practice Address - Street 1:276 NEWPORT RD STE 107
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5468
Practice Address - Country:US
Practice Address - Phone:603-526-4144
Practice Address - Fax:603-526-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3129987Medicaid