Provider Demographics
NPI:1518738392
Name:1918 WINTER STREET OPERATING CO LLC
Entity Type:Organization
Organization Name:1918 WINTER STREET OPERATING CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-354-4619
Mailing Address - Street 1:7 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-5042
Mailing Address - Country:US
Mailing Address - Phone:603-354-7000
Mailing Address - Fax:
Practice Address - Street 1:12442 W KEN CARYL AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3745
Practice Address - Country:US
Practice Address - Phone:303-978-0184
Practice Address - Fax:303-971-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies