Provider Demographics
NPI:1356777825
Name:PINEWOOD PROFESSIONALS, LLC
Entity type:Organization
Organization Name:PINEWOOD PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-692-3166
Mailing Address - Street 1:255 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1543
Mailing Address - Country:US
Mailing Address - Phone:603-692-3166
Mailing Address - Fax:603-692-3168
Practice Address - Street 1:22 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4987
Practice Address - Country:US
Practice Address - Phone:603-415-0090
Practice Address - Fax:603-692-3168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEWOOD PROFESSIONALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies