Healthcare Provider Details

I. General information

NPI: 1104819606
Provider Name (Legal Business Name): CITY OF BERLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 MAIN ST
BERLIN NH
03570-2420
US

IV. Provider business mailing address

168 MAIN ST
BERLIN NH
03570-2420
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-1272
  • Fax: 603-752-5238
Mailing address:
  • Phone: 603-752-1272
  • Fax: 603-752-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number01267
License Number StateNH

VIII. Authorized Official

Name: MS. LAURA LEE VIGER
Title or Position: COMMUNITY SERVICES DIRECTOR
Credential:
Phone: 603-752-1272