Healthcare Provider Details

I. General information

NPI: 1053319517
Provider Name (Legal Business Name): COUNTY OF GRAFTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL NH
03774-4909
US

IV. Provider business mailing address

3855 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL NH
03774-4909
US

V. Phone/Fax

Practice location:
  • Phone: 603-787-6971
  • Fax: 603-787-2035
Mailing address:
  • Phone: 603-787-6971
  • Fax: 603-787-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1053319517
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00214
License Number StateNH

VIII. Authorized Official

Name: DAWN L JURENTKUFF
Title or Position: CFO
Credential:
Phone: 603-787-6971