Healthcare Provider Details

I. General information

NPI: 1417302977
Provider Name (Legal Business Name): RIVER WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 CHURCH ST
LACONIA NH
03246-3403
US

IV. Provider business mailing address

96 CHURCH ST
LACONIA NH
03246-3430
US

V. Phone/Fax

Practice location:
  • Phone: 603-159-2895
  • Fax:
Mailing address:
  • Phone: 603-759-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL C BARTLETT
Title or Position: OWNER
Credential:
Phone: 603-759-2895