Healthcare Provider Details

I. General information

NPI: 1073663340
Provider Name (Legal Business Name): TOWN OF MOULTONBOROUGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HOLLAND STREET
MOULTONBOROUGH NH
03254
US

IV. Provider business mailing address

PO BOX 138 6 HOLLAND ST
MOULTONBOROUGH NH
03254-0138
US

V. Phone/Fax

Practice location:
  • Phone: 603-476-2350
  • Fax: 603-476-5811
Mailing address:
  • Phone: 603-476-2350
  • Fax: 603-476-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number01372
License Number StateNH

VIII. Authorized Official

Name: MRS. DEBRA JAYNE PEASLEE
Title or Position: DIRECTOR
Credential: RN
Phone: 603-476-2350