Healthcare Provider Details

I. General information

NPI: 1902176134
Provider Name (Legal Business Name): COMMUNITY BASED TRAINING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PERSHING ST
NASHUA NH
03060-3645
US

IV. Provider business mailing address

24 PERSHING ST
NASHUA NH
03060-3645
US

V. Phone/Fax

Practice location:
  • Phone: 941-238-7646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID HAWTHORNE
Title or Position: DIRECTOR
Credential:
Phone: 941-238-7646