Provider Demographics
NPI:1710491808
Name:DDP FORTUNA INC.
Entity Type:Organization
Organization Name:DDP FORTUNA INC.
Other - Org Name:GRISWOLD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-967-4477
Mailing Address - Street 1:1 LIBERTY LN E STE 12
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1839
Mailing Address - Country:US
Mailing Address - Phone:603-967-4477
Mailing Address - Fax:603-677-1110
Practice Address - Street 1:1 LIBERTY LN E STE 12
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1839
Practice Address - Country:US
Practice Address - Phone:603-967-4477
Practice Address - Fax:603-677-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03800253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care