Healthcare Provider Details

I. General information

NPI: 1689860306
Provider Name (Legal Business Name): ROCKINGHAM FAMILY HEALTHCARE COLLABORATIVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 ISLAND POND RD
ATKINSON NH
03811-2128
US

IV. Provider business mailing address

58 ISLAND POND RD
ATKINSON NH
03811-2128
US

V. Phone/Fax

Practice location:
  • Phone: 603-362-4444
  • Fax:
Mailing address:
  • Phone: 603-362-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0225422303
License Number StateNH

VIII. Authorized Official

Name: MR. GLENN DITULIO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 603-362-4444