Healthcare Provider Details

I. General information

NPI: 1548317852
Provider Name (Legal Business Name): LAKES REGION COMMUNITY SERVICES COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 COMMUNICATION DR
LACONIA NH
03246-1440
US

IV. Provider business mailing address

PO BOX 509
LACONIA NH
03247-0509
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-8811
  • Fax: 603-524-0702
Mailing address:
  • Phone: 603-524-8811
  • Fax: 603-524-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA L BRYANT
Title or Position: CFO
Credential:
Phone: 603-524-8811