Healthcare Provider Details

I. General information

NPI: 1265695969
Provider Name (Legal Business Name): GOODWIN COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DR SUITE 12
PORTSMOUTH NH
03801-5892
US

IV. Provider business mailing address

311 ROUTE 108
SOMERSWORTH NH
03878-1522
US

V. Phone/Fax

Practice location:
  • Phone: 603-422-8208
  • Fax: 603-422-8218
Mailing address:
  • Phone: 603-422-8208
  • Fax: 603-422-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GARCA
Title or Position: BILLING MANAGER
Credential:
Phone: 603-422-8208