Provider Demographics
NPI:1700880739
Name:CAROL A BRODY
Entity Type:Organization
Organization Name:CAROL A BRODY
Other - Org Name:LAKES REGION NURSING CARE AND COMFORT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:603-528-5020
Mailing Address - Street 1:102 COURT ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3635
Mailing Address - Country:US
Mailing Address - Phone:603-528-5020
Mailing Address - Fax:603-528-0352
Practice Address - Street 1:102 COURT ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3635
Practice Address - Country:US
Practice Address - Phone:603-528-5020
Practice Address - Fax:603-528-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03606251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40597252OtherHCBC
NH40600228Medicaid