Nic 15 Kirkwood Corners Leasing LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

02985 Issued in NH

Legal business name

NIC 15 KIRKWOOD CORNERS LEASING LLC

Doing business as

Kirkwood Corners

Practice address

206 N River Rd
Lee, NH 03861-6214

Phone

(603) 659-6586

NPI assigned

Mar 7, 2014

Last updated

Mar 26, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul Boethel

Title

Ceo

Phone

(469) 304-5033

Specialties & licenses 1

Addresses

Other names 1

• Kirkwood Corners Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1689090292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 DALLAS PKWY",
            "address_2": "380",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935980",
            "telephone_number": "469-304-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N RIVER RD",
            "city": "LEE",
            "state": "NH",
            "postal_code": "038616214",
            "telephone_number": "603-659-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 15 KIRKWOOD CORNERS LEASING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-07",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "BOETHEL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-304-5033"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NH",
            "license": "02985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kirkwood Corners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ann Marie Miller, DMD
• Chantelle Mitchell, PHARMD
• Amy Melissa Morley, MS, CCC-SLP
• Kelsey Jo Motto, DPT
• Alyssa Neslusan
• Ashley Jordan Norris, CRNA, PMHNP
• Emily S Pascoe, RD, LDN
• Shelly Perry, RPH
• Taylor Ellen Prendergast-Moore, OTR/L
• Sara Richards

• Assisted Living Facility in Lee, NH
• Providers in Lee, NH by specialty
• Assisted Living Facility in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.