Healthcare Provider Details

I. General information

NPI: 1437341013
Provider Name (Legal Business Name): VINTAGE HILL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BERRY AVE
PITTSFIELD NH
03263-3400
US

IV. Provider business mailing address

10 BERRY AVE
PITTSFIELD NH
03263-3400
US

V. Phone/Fax

Practice location:
  • Phone: 603-435-5133
  • Fax: 603-435-5177
Mailing address:
  • Phone: 603-435-5133
  • Fax: 603-435-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number03084
License Number StateNH

VIII. Authorized Official

Name: MISS LINDA PAULINE SMALL
Title or Position: MEMBER
Credential:
Phone: 603-435-5133