Healthcare Provider Details

I. General information

NPI: 1326224411
Provider Name (Legal Business Name): NASHUA CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AMHERST ST
NASHUA NH
03064-2043
US

IV. Provider business mailing address

125 AMHERST ST
NASHUA NH
03064-2043
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-3851
  • Fax: 603-883-5925
Mailing address:
  • Phone: 603-883-3851
  • Fax: 603-883-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1069
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1069
License Number StateNH

VIII. Authorized Official

Name: MR. DAVID VILLIOTTI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 603-883-3851