Provider Demographics
NPI:1831614692
Name:HENRY KENGONG NTORO LLC
Entity type:Organization
Organization Name:HENRY KENGONG NTORO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NTORO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:978-328-7650
Mailing Address - Street 1:144 MERRIMACK ST STE 441
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1709
Mailing Address - Country:US
Mailing Address - Phone:978-328-7650
Mailing Address - Fax:
Practice Address - Street 1:144 MERRIMACK ST STE 441
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1709
Practice Address - Country:US
Practice Address - Phone:978-328-7650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty