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General NPI Number Information
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NPI Number | 1417313123
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Entity Type | Organization
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Legal Business Name | AGE AT HOME, LLC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 30 S MAIN ST STE 203-205
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City | CONCORD
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State | NH
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Zip | 03301-4809
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Country | US
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Telephone | 603-224-6100
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Fax | 603-224-6102
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Provider Business Mailing Address
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Address Line | 30 S MAIN ST STE 203-205
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City | CONCORD
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State | NH
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Zip | 03301-4809
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Country | US
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Telephone | 603-224-6100
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Fax | 603-224-6102
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LAUREL M TRAHAN
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Credential | CMC
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Telephone | 603-224-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 03938
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License Number State | NH
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