Healthcare Provider Details

I. General information

NPI: 1114460284
Provider Name (Legal Business Name): AWARE RECOVERY CARE OF NEW HAMPSHIRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CONSTITUTION DR UNIT 2N
BEDFORD NH
03110-6042
US

IV. Provider business mailing address

556 WASHINGTON AVE SUITE 201
NORTH HAVEN CT
06473-1149
US

V. Phone/Fax

Practice location:
  • Phone: 203-779-5799
  • Fax: 203-421-6830
Mailing address:
  • Phone: 203-779-5799
  • Fax: 203-421-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GEORGE MERHI
Title or Position: CFO
Credential:
Phone: 203-799-5799