Provider Demographics
NPI:1912906959
Name:LAKES REGION VISITING NURSE ASSOCIATION
Entity Type:Organization
Organization Name:LAKES REGION VISITING NURSE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-279-6611
Mailing Address - Street 1:186 WAUKEWAN ST
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6023
Mailing Address - Country:US
Mailing Address - Phone:603-279-6611
Mailing Address - Fax:603-279-2256
Practice Address - Street 1:186 WAUKEWAN ST
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-6023
Practice Address - Country:US
Practice Address - Phone:603-279-6611
Practice Address - Fax:603-279-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02708251E00000X
NH03714251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7HKOtherANTHEM BLUE CROSS
NH3078140OtherMEDICAID HCBC
NH3078971Medicaid
307013Medicare Oscar/Certification