Healthcare Provider Details

I. General information

NPI: 1780815316
Provider Name (Legal Business Name): AVIS GOODWIN COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 SOMERSWORTH RD
NORTH BERWICK ME
03906-6559
US

IV. Provider business mailing address

652F CENTRAL AVE # F
DOVER NH
03820-3414
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-2570
  • Fax: 603-953-0066
Mailing address:
  • Phone: 603-516-5270
  • Fax: 603-953-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET ATKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 603-516-2570