=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114176716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2008
-----------------------------------------------------
Last Update Date | 03/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 536 COTTAGE ST
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03561-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-444-5317
-----------------------------------------------------
Fax | 603-444-0980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 536 COTTAGE ST
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03561-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-444-5317
-----------------------------------------------------
Fax | 603-444-0980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. ELAINE BUSSEY
-----------------------------------------------------
Credential | RN, MS
-----------------------------------------------------
Telephone | 603-444-5317
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 02236
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------