Healthcare Provider Details

I. General information

NPI: 1194960229
Provider Name (Legal Business Name): APPLEGATE GARDENS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MOUNTAIN RD
CENTER TUFTONBORO NH
03816-5053
US

IV. Provider business mailing address

PO BOX 644
WOLFEBORO FALLS NH
03896-0644
US

V. Phone/Fax

Practice location:
  • Phone: 603-539-1080
  • Fax: 603-539-1080
Mailing address:
  • Phone: 603-539-1080
  • Fax: 603-539-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number03380
License Number StateNH

VIII. Authorized Official

Name: MR. TERRY MITCHELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-539-1080