Provider Demographics
NPI:1346048824
Name:FONTANELLE LLC
Entity type:Organization
Organization Name:FONTANELLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:603-680-6748
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242-0194
Mailing Address - Country:US
Mailing Address - Phone:603-680-6748
Mailing Address - Fax:
Practice Address - Street 1:544 WARNER RD
Practice Address - Street 2:
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242
Practice Address - Country:US
Practice Address - Phone:603-680-6748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management