Provider Demographics
NPI:1679261903
Name:INDEPENDENT HOMECARE LLC
Entity Type:Organization
Organization Name:INDEPENDENT HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMBLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-407-0004
Mailing Address - Street 1:82 FITZGERALD DR. UNIT 1B STE 100
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452
Mailing Address - Country:US
Mailing Address - Phone:603-407-0004
Mailing Address - Fax:
Practice Address - Street 1:82 FITZGERALD DR. UNIT 1B STE 100
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452
Practice Address - Country:US
Practice Address - Phone:603-407-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health