Healthcare Provider Details

I. General information

NPI: 1942669486
Provider Name (Legal Business Name): GM HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S RIVER RD BLDG 1 STE 208
BEDFORD NH
03110-6941
US

IV. Provider business mailing address

170 S RIVER RD BLDG 1 STE 208
BEDFORD NH
03110-6941
US

V. Phone/Fax

Practice location:
  • Phone: 603-637-4646
  • Fax: 603-935-8590
Mailing address:
  • Phone: 603-637-4646
  • Fax: 603-935-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number04114
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04114
License Number StateNH

VIII. Authorized Official

Name: MELISSA JANICKE
Title or Position: OWNER
Credential:
Phone: 603-498-7864