Healthcare Provider Details

I. General information

NPI: 1992750764
Provider Name (Legal Business Name): CFN MANCHESTER NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SUNCOOK VALLEY HWY
EPSOM NH
03234-4329
US

IV. Provider business mailing address

901 SUNCOOK VALLEY HWY
EPSOM NH
03234-4329
US

V. Phone/Fax

Practice location:
  • Phone: 603-736-4772
  • Fax:
Mailing address:
  • Phone: 603-736-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number02854
License Number StateNH

VII. Legacy identifiers

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

# 1
Identifier30101898
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier0305080
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerBC BS NH

VIII. Authorized Official

Name: WILLIAM T RICHMOND
Title or Position: PRESIDENT
Credential:
Phone: 615-459-6094