Healthcare Provider Details

I. General information

NPI: 1972629582
Provider Name (Legal Business Name): COUNTY OF ROCKINGHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NORTH RD
BRENTWOOD NH
03833-6624
US

IV. Provider business mailing address

117 NORTH RD
BRENTWOOD NH
03833-6624
US

V. Phone/Fax

Practice location:
  • Phone: 603-679-5335
  • Fax:
Mailing address:
  • Phone: 603-679-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number105
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number2202
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number02934
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number105
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number105
License Number StateNH

VIII. Authorized Official

Name: CHARLES NICKERSON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 603-679-9341