Healthcare Provider Details

I. General information

NPI: 1194817684
Provider Name (Legal Business Name): LRG HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N MAIN ST
LACONIA NH
03246-2742
US

IV. Provider business mailing address

PO BOX 10005
LEWISTON ME
04243-9432
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-5151
  • Fax:
Mailing address:
  • Phone: 603-524-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PATTERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 603-524-5151