Healthcare Provider Details

I. General information

NPI: 1427417104
Provider Name (Legal Business Name): GREAT BAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CATARACT AVE # 1
DOVER NH
03820-3908
US

IV. Provider business mailing address

23 CATARACT AVE # 1
DOVER NH
03820-3908
US

V. Phone/Fax

Practice location:
  • Phone: 603-842-5344
  • Fax: 603-343-4465
Mailing address:
  • Phone: 603-842-5344
  • Fax: 603-343-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: PAMELA ANN LOWY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-435-4365