Provider Demographics
NPI:1962916098
Name:LISA KUNZ
Entity type:Organization
Organization Name:LISA KUNZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:800-381-6478
Mailing Address - Street 1:12 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-2032
Mailing Address - Country:US
Mailing Address - Phone:513-505-6970
Mailing Address - Fax:
Practice Address - Street 1:12 CLIFF RD
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-2032
Practice Address - Country:US
Practice Address - Phone:513-505-6970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care