Provider Demographics
NPI:1649222357
Name:VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY
Entity Type:Organization
Organization Name:VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-356-7006
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-0432
Mailing Address - Country:US
Mailing Address - Phone:603-356-7006
Mailing Address - Fax:603-356-8134
Practice Address - Street 1:1529 WHITE MOUNTAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5355
Practice Address - Country:US
Practice Address - Phone:603-356-7006
Practice Address - Fax:603-356-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02737251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80307020Medicaid
NH99591033Medicaid
NH307020OtherANTHEM BCBS PROVIDER #
NH307020OtherPTAN