Provider Demographics
NPI:1982730693
Name:ANDROSCOGGIN VALLEY HOME CARE SERVICES
Entity Type:Organization
Organization Name:ANDROSCOGGIN VALLEY HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:C
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:603-752-7505
Mailing Address - Street 1:795 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2437
Mailing Address - Country:US
Mailing Address - Phone:603-752-7505
Mailing Address - Fax:603-752-4317
Practice Address - Street 1:795 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2437
Practice Address - Country:US
Practice Address - Phone:603-752-7505
Practice Address - Fax:603-752-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01938251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99591005Medicaid