Healthcare Provider Details

I. General information

NPI: 1285798090
Provider Name (Legal Business Name): NEW HAMPSHIRE ODD FELLOWS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PLEASANT ST
CONCORD NH
03301-2505
US

IV. Provider business mailing address

200 PLEASANT ST
CONCORD NH
03301-2505
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-6644
  • Fax: 603-226-2198
Mailing address:
  • Phone: 603-225-6644
  • Fax: 603-226-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1817
License Number StateNH

VIII. Authorized Official

Name: MARYANN SMITH
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 603-724-6161