Provider Demographics
NPI:1598208076
Name:HOME
Entity Type:Organization
Organization Name:HOME
Other - Org Name:WORK
Other - Org Type:Other Name
Authorized Official - Title/Position:STUDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-508-8029
Mailing Address - Street 1:7 PEAR ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:CLEARMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-508-8029
Mailing Address - Fax:
Practice Address - Street 1:7 PEAR ST UNIT C
Practice Address - Street 2:
Practice Address - City:CLEARMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-508-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare