Healthcare Provider Details

I. General information

NPI: 1376530246
Provider Name (Legal Business Name): MOUNT CARMEL REHABILITATION & NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MYRTLE ST
MANCHESTER NH
03104-4314
US

IV. Provider business mailing address

235 MYRTLE ST
MANCHESTER NH
03104-4314
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-3811
  • Fax: 603-626-4696
Mailing address:
  • Phone: 603-627-3811
  • Fax: 603-626-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00580
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30593558
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier99006643
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: MR. JOE BOHUNICKY
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-627-3811