Healthcare Provider Details

I. General information

NPI: 1174974505
Provider Name (Legal Business Name): CONCORD BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 N STATE ST
CONCORD NH
03301-4334
US

IV. Provider business mailing address

PO BOX 3632
CONCORD NH
03302-3632
US

V. Phone/Fax

Practice location:
  • Phone: 603-272-6500
  • Fax:
Mailing address:
  • Phone: 603-272-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number16062
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number070693-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number057528-23
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12448
License Number StateNH

VIII. Authorized Official

Name: DR. LINDA PAULA CALL
Title or Position: MANAGER
Credential: M.D.
Phone: 603-272-6500