Healthcare Provider Details

I. General information

NPI: 1194280636
Provider Name (Legal Business Name): THREE RIVERS HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WELLMAN AVE STE 110
NASHUA NH
03064-1463
US

IV. Provider business mailing address

2 WELLMAN AVE STE 110
NASHUA NH
03064-1463
US

V. Phone/Fax

Practice location:
  • Phone: 603-336-3999
  • Fax: 603-336-3995
Mailing address:
  • Phone: 603-336-3999
  • Fax: 603-336-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW KOPSER
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-336-3999