Healthcare Provider Details

I. General information

NPI: 1679698765
Provider Name (Legal Business Name): CENTRAL NEW HAMPSHIRE KIDNEY CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SPRING STREET
LACONIA NH
03246
US

IV. Provider business mailing address

87 SPRING STREET
LACONIA NH
03246
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-3738
  • Fax: 603-524-8796
Mailing address:
  • Phone: 603-528-3738
  • Fax: 603-524-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number1641
License Number StateNH

VIII. Authorized Official

Name: NOSHI A ISHAK
Title or Position: CEO MEDICAL DIRECTOR
Credential: MD
Phone: 603-528-3738