Healthcare Provider Details

I. General information

NPI: 1164607032
Provider Name (Legal Business Name): HANNAH HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ABBOTT ST
LEBANON NH
03766-1615
US

IV. Provider business mailing address

PO BOX 591
LEBANON NH
03766-0591
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-5339
  • Fax: 603-448-5398
Mailing address:
  • Phone: 603-448-5339
  • Fax: 603-448-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RANDY PAUL WALKER JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED. COUNSELIN
Phone: 603-448-5339