Provider Demographics
NPI:1205614302
Name:OVERFIFTY - 360 CORP
Entity type:Organization
Organization Name:OVERFIFTY - 360 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-483-8999
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NH
Mailing Address - Zip Code:03032-0290
Mailing Address - Country:US
Mailing Address - Phone:603-483-8999
Mailing Address - Fax:
Practice Address - Street 1:14 HOOKSETT ROAD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NH
Practice Address - Zip Code:03032
Practice Address - Country:US
Practice Address - Phone:603-483-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care