Healthcare Provider Details

I. General information

NPI: 1043334626
Provider Name (Legal Business Name): STATE OF NEW HAMPSHIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 PLEASANT ST HOWARD RECREATION CENTER
CONCORD NH
03301-3852
US

IV. Provider business mailing address

99 PLEASANT ST HOWARD RECREATION CENTER
CONCORD NH
03301-3852
US

V. Phone/Fax

Practice location:
  • Phone: 603-271-5261
  • Fax: 603-271-5729
Mailing address:
  • Phone: 603-271-5261
  • Fax: 603-271-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DENNIS M. D'OVIDIO
Title or Position: DIRECTOR TRANSITIONAL HOUSING SERVI
Credential: MSW
Phone: 603-271-5390