30D2157938 CLIA NUMBER - FOUNTAINS OF HEALTH PRIMARY CARE

Laboratory Demographics

CLIA Number: 30D2157938

Facility Name: FOUNTAINS OF HEALTH PRIMARY CARE

Facility Address:
7 TAGGART DR, STE E
NASHUA, NH
ZIP 03060
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Facility Phone Number: 603 943-8923

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1457816019

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	30D2157938
LAB Type	Practitioner Other
Facility Name	FOUNTAINS OF HEALTH PRIMARY CARE
Street	7 TAGGART DR, STE E
City	NASHUA
State	NH
ZIP	03060
Phone	603 943-8923
CertificateType	4
CertificateEffectiveDate	11/16/2022
CertificateExpirationDate	11/15/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024