MEDICARE: J & M MULLEN ENTERPRISE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	03653	NH

General Provider Information

NPI Number	:	1851694434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J & M MULLEN ENTERPRISE, LLC

Provider Business Mailing Address
First Line	:	90 WASHINGTON ST
Second Line	:	SUITE 212
City	:	DOVER
State	:	NH
Zip	:	03820-3744
Country	:	US
Telephone Number	:	603-842-4088
Fax Number	:	603-842-4082

Provider Business Practice Location Address
First Line	:	90 WASHINGTON ST
Second Line	:	SUITE 212
City	:	DOVER
State	:	NH
Zip	:	03820-3744
Country	:	US
Telephone Number	:	603-842-4088
Fax Number	:	603-842-4082

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN E MULLEN
Credential	:
Telephone Number	:	603-842-4088

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	12/21/2010

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