Provider Demographics
NPI:1518953397
Name:LAKE SUNAPEE HOMECARE AND HOSPICE
Entity Type:Organization
Organization Name:LAKE SUNAPEE HOMECARE AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CULHANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-526-4077
Mailing Address - Street 1:PO BOX 2209
Mailing Address - Street 2:107 NEWPORT ROAD
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-2209
Mailing Address - Country:US
Mailing Address - Phone:603-526-4077
Mailing Address - Fax:603-526-4272
Practice Address - Street 1:107 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5415
Practice Address - Country:US
Practice Address - Phone:603-526-4077
Practice Address - Fax:603-526-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03031251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH307040OtherHCH BCBS PROV NUMBER
NH7HWOtherNEW BCBS HCH PROV NUMBER
NH30004854OtherCHS HCBC PROV NUMBER
NH702129OtherHARVARD PILGRIM PROV #
NH30005518Medicaid
NH99591039OtherHCH HCBC PROV NUMBER
NH2453OtherCIGNA HCH PIN NUMBER
NH30011244OtherMSW MEDICAID PROV NUMBER
NH80307040Medicaid
NH80307040Medicaid