Healthcare Provider Details

I. General information

NPI: 1013121482
Provider Name (Legal Business Name): PILOT HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CASTLE ST
KEENE NH
03431-3307
US

IV. Provider business mailing address

105 CASTLE ST
KEENE NH
03431-3307
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-1922
  • Fax: 603-352-8822
Mailing address:
  • Phone: 603-357-1922
  • Fax: 603-352-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number03265
License Number StateNH

VIII. Authorized Official

Name: MELINDA FEOLA-MAHAR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 603-357-1922