Provider Demographics
NPI:1811256985
Name:OCIUS CARE
Entity type:Organization
Organization Name:OCIUS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:603-287-1717
Mailing Address - Street 1:111 US ROUTE 4A
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2119
Mailing Address - Country:US
Mailing Address - Phone:603-287-1717
Mailing Address - Fax:603-287-1410
Practice Address - Street 1:52 OPERA HOUSE SQ
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-5407
Practice Address - Country:US
Practice Address - Phone:603-287-1717
Practice Address - Fax:603-287-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037311-23261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center