Provider Demographics
NPI:1558038711
Name:PROFESSIONAL HEALTHCARE TRAINING
Entity type:Organization
Organization Name:PROFESSIONAL HEALTHCARE TRAINING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:207-317-1649
Mailing Address - Street 1:110 HARRISBURG AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2153
Mailing Address - Country:US
Mailing Address - Phone:207-317-1649
Mailing Address - Fax:
Practice Address - Street 1:110 HARRISBURG AVE
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2153
Practice Address - Country:US
Practice Address - Phone:207-317-1649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty