Healthcare Provider Details

I. General information

NPI: 1679261903
Provider Name (Legal Business Name): INDEPENDENT HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 FITZGERALD DR. UNIT 1B STE 100
JAFFREY NH
03452
US

IV. Provider business mailing address

82 FITZGERALD DR. UNIT 1B STE 100
JAFFREY NH
03452
US

V. Phone/Fax

Practice location:
  • Phone: 603-407-0004
  • Fax:
Mailing address:
  • Phone: 603-407-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHANNON TREMBLAY
Title or Position: OWNER/MANAGER
Credential:
Phone: 603-407-0004