Provider Demographics
NPI:1124161393
Name:FANARAS ENTERPRISES
Entity type:Organization
Organization Name:FANARAS ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FANARAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:603-224-9591
Mailing Address - Street 1:125 N MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4921
Mailing Address - Country:US
Mailing Address - Phone:603-224-9591
Mailing Address - Fax:603-224-3901
Practice Address - Street 1:125 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4921
Practice Address - Country:US
Practice Address - Phone:603-224-9591
Practice Address - Fax:603-224-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009245Medicaid
NH80009245Medicaid