Healthcare Provider Details

I. General information

NPI: 1629594718
Provider Name (Legal Business Name): 55 HARRIS ROAD OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HARRIS RD
NASHUA NH
03062-2145
US

IV. Provider business mailing address

55 HARRIS RD
NASHUA NH
03062-2145
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-1573
  • Fax:
Mailing address:
  • Phone: 603-888-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMA

VIII. Authorized Official

Name: WILLIAM H STEPHAN
Title or Position: CFO
Credential:
Phone: 617-943-7747