Provider Demographics
NPI:1720631278
Name:BLUEBERRY MOUNTAIN HEALTH, LLC
Entity type:Organization
Organization Name:BLUEBERRY MOUNTAIN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:339-927-5272
Mailing Address - Street 1:16 TODDY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6270
Mailing Address - Country:US
Mailing Address - Phone:339-927-5272
Mailing Address - Fax:
Practice Address - Street 1:10 RESEARCH PL STE 202
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2439
Practice Address - Country:US
Practice Address - Phone:978-275-1390
Practice Address - Fax:978-275-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty