Provider Demographics
NPI:1669512794
Name:SOLAMOR HOSPICE CORPORATION
Entity type:Organization
Organization Name:SOLAMOR HOSPICE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:170 SOUTH RIVER ROAD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6941
Mailing Address - Country:US
Mailing Address - Phone:603-606-7974
Mailing Address - Fax:603-606-7988
Practice Address - Street 1:170 SOUTH RIVER ROAD
Practice Address - Street 2:BUILDING 2
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6941
Practice Address - Country:US
Practice Address - Phone:603-606-7974
Practice Address - Fax:603-606-7988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLAMOR HOPSICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
NH03256251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA301528Medicare Oscar/Certification
301528Medicare Oscar/Certification