Healthcare Provider Details

I. General information

NPI: 1700955028
Provider Name (Legal Business Name): NORTHERN HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 EASTMAN RD STE B
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 TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWN BROMLEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 603-447-8022