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General NPI Number Information
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NPI Number | 1881100022
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Entity Type | Organization
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Legal Business Name | MCCLEARY ASSISTED LIVING SERVICES LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 212 SUMMER ST
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City | BRISTOL
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State | NH
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Zip | 03222-3208
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Country | US
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Telephone | 603-744-8402
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Fax |
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Provider Business Mailing Address
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Address Line | 212 SUMMER ST
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City | BRISTOL
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State | NH
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Zip | 03222-3208
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Country | US
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Telephone | 603-744-8402
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JACOB MCCLEARY
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Credential | RN
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Telephone | 603-770-9625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 04245
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License Number State | NH
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