Provider Demographics
NPI:1891921201
Name:MALLORY DREW
Entity Type:Organization
Organization Name:MALLORY DREW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL CARE ASSISTENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:ALYCE
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-264-9842
Mailing Address - Street 1:5 LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:CHICHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03258-6126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 HARVEST RD
Practice Address - Street 2:
Practice Address - City:CHICHESTER
Practice Address - State:NH
Practice Address - Zip Code:03258-6545
Practice Address - Country:US
Practice Address - Phone:603-798-5193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035955-24313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility