Healthcare Provider Details

I. General information

NPI: 1538437900
Provider Name (Legal Business Name): GREATER NASHUA COUNCIL ON ALCOHOLISM-KEYSTONE HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 AMHERST ST
NASHUA NH
03063-1052
US

IV. Provider business mailing address

615 AMHERST ST
NASHUA NH
03063-1052
US

V. Phone/Fax

Practice location:
  • Phone: 603-881-4848
  • Fax: 603-598-3644
Mailing address:
  • Phone: 603-881-4848
  • Fax: 603-598-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0484
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNH

VIII. Authorized Official

Name: MS. ALEXANDRA HAMEL
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: MLADC
Phone: 603-881-4848