Healthcare Provider Details

I. General information

NPI: 1790150985
Provider Name (Legal Business Name): LIVE FREE HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 NH ROUTE 104
NEW HAMPTON NH
03256-4224
US

IV. Provider business mailing address

438 NH ROUTE 104
NEW HAMPTON NH
03256-4224
US

V. Phone/Fax

Practice location:
  • Phone: 603-217-0149
  • Fax:
Mailing address:
  • Phone: 603-217-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04126
License Number StateNH

VIII. Authorized Official

Name: JOHN PHILLIPS
Title or Position: PRESIDENT
Credential:
Phone: 847-281-4860