Healthcare Provider Details

I. General information

NPI: 1952415812
Provider Name (Legal Business Name): CHESHIRE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST
KEENE NH
03431-1718
US

IV. Provider business mailing address

580 COURT ST
KEENE NH
03431-1718
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number00014
License Number StateNH

VIII. Authorized Official

Name: DON CARUSO
Title or Position: CEO
Credential: MD
Phone: 603-354-5454