Provider Demographics
NPI:1467680488
Name:PEGGY BERLUCCHI
Entity Type:Organization
Organization Name:PEGGY BERLUCCHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-458-2149
Mailing Address - Street 1:16 HIGHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 HIGHMOOR DR
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:ME
Practice Address - Zip Code:04263-3823
Practice Address - Country:US
Practice Address - Phone:207-458-2149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care