Healthcare Provider Details

I. General information

NPI: 1609312867
Provider Name (Legal Business Name): SEACOAST LACTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 NEWINGTON RD
NEWINGTON NH
03801-2730
US

IV. Provider business mailing address

436 NEWINGTON RD
NEWINGTON NH
03801-2730
US

V. Phone/Fax

Practice location:
  • Phone: 508-280-8371
  • Fax:
Mailing address:
  • Phone: 508-280-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number051078-21
License Number StateNY

VIII. Authorized Official

Name: MRS. LAURA LEE STONE
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 508-280-8371