Provider Demographics
NPI:1710279690
Name:OURLIFE INC.
Entity Type:Organization
Organization Name:OURLIFE INC.
Other - Org Name:RENEW HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/V PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FANEUF
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:603-319-1701
Mailing Address - Street 1:485 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2349
Mailing Address - Country:US
Mailing Address - Phone:603-319-1701
Mailing Address - Fax:603-319-1713
Practice Address - Street 1:750 LAFAYETTE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5407
Practice Address - Country:US
Practice Address - Phone:603-319-1701
Practice Address - Fax:603-319-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH584237700000X
NHH573237700000X
MA242237700000X
MA287237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3086908Medicaid