Healthcare Provider Details

I. General information

NPI: 1427182286
Provider Name (Legal Business Name): NORTHERN HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 EASTMAN RD STE C
CENTER CONWAY NH
03813-4219
US

IV. Provider business mailing address

626 EASTMAN RD STE A
CENTER CONWAY NH
03813-4219
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-3347
  • Fax: 603-447-8893
Mailing address:
  • Phone: 603-447-3347
  • Fax: 603-447-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWN M BROMLEY
Title or Position: CFO
Credential:
Phone: 603-447-8022