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General NPI Number Information
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NPI Number | 1760857528
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Entity Type | Organization
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Legal Business Name | ALL ELEMENTS HEALING REVOLUTION
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 51 S MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-4828
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Country | US
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Telephone | 603-225-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 51 S MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-4828
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Country | US
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Telephone | 603-225-5554
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JESSICA GORHAN
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Credential | LMT
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Telephone | 603-225-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 6126 M
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License Number State | NH
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