Healthcare Provider Details

I. General information

NPI: 1053954925
Provider Name (Legal Business Name): KATIE MCCABE LNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VILLAGE RD
FREEDOM NH
03836-4937
US

IV. Provider business mailing address

150 VILLAGE RD
FREEDOM NH
03836-4937
US

V. Phone/Fax

Practice location:
  • Phone: 603-651-9280
  • Fax:
Mailing address:
  • Phone: 603-651-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number045532-24
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: