Healthcare Provider Details

I. General information

NPI: 1497375323
Provider Name (Legal Business Name): DOWNETOWN BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MILL PLZ
LACONIA NH
03246-3438
US

IV. Provider business mailing address

PO BOX 381
LACONIA NH
03247-0381
US

V. Phone/Fax

Practice location:
  • Phone: 603-945-4561
  • Fax:
Mailing address:
  • Phone: 603-945-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMANTHA DOWNES
Title or Position: MANAGER/OWNER OF BUSINESS
Credential:
Phone: 561-252-1286