Healthcare Provider Details

I. General information

NPI: 1518367002
Provider Name (Legal Business Name): STRAFFORD COUNTY COMMUNITY ACTION COMMITTEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 CENTRAL AVE
DOVER NH
03820-3414
US

IV. Provider business mailing address

PO BOX 160
DOVER NH
03821-0160
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-8192
  • Fax:
Mailing address:
  • Phone: 603-516-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3086011
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: MELISSA ADAMS
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 603-516-8192