Healthcare Provider Details

I. General information

NPI: 1235744087
Provider Name (Legal Business Name): SGI REALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GARRISON RD
DOVER NH
03820-4590
US

IV. Provider business mailing address

150 GARRISON RD
DOVER NH
03820-4590
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-8888
  • Fax: 603-516-8889
Mailing address:
  • Phone: 603-516-8888
  • Fax: 603-516-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JOHN HOPKINS
Title or Position: OWNER
Credential:
Phone: 603-516-8888