=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467680488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEGGY BERLUCCHI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2009
-----------------------------------------------------
Last Update Date | 06/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 HIGHMOOR DR
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04263-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-458-2149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 HIGHMOOR DR
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04263-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PEGGY BERLUCCHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-458-2149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------