Provider Demographics
NPI:1568520047
Name:LABELLE'S SHOE REPAIR LLC
Entity Type:Organization
Organization Name:LABELLE'S SHOE REPAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-528-1528
Mailing Address - Street 1:612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3448
Mailing Address - Country:US
Mailing Address - Phone:603-528-1528
Mailing Address - Fax:603-528-1528
Practice Address - Street 1:612 MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3448
Practice Address - Country:US
Practice Address - Phone:603-528-1528
Practice Address - Fax:603-528-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5856890001Medicare NSC