Healthcare Provider Details

I. General information

NPI: 1023108354
Provider Name (Legal Business Name): LRGHEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SCHOOL ST
BRISTOL NH
03222-3263
US

IV. Provider business mailing address

PO BOX 1327
LACONIA NH
03247-1327
US

V. Phone/Fax

Practice location:
  • Phone: 603-744-5441
  • Fax: 603-744-3698
Mailing address:
  • Phone: 603-524-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNH

VIII. Authorized Official

Name: MR. KEVIN W DONOVAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 603-524-3211