Healthcare Provider Details

I. General information

NPI: 1609143924
Provider Name (Legal Business Name): GAFNEY HOME FOR THE AGED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WAKEFIELD ST
ROCHESTER NH
03867-1921
US

IV. Provider business mailing address

90 WAKEFIELD ST
ROCHESTER NH
03867-1921
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-2705
  • Fax:
Mailing address:
  • Phone: 603-332-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number00118
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number00118
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00118
License Number StateNH

VIII. Authorized Official

Name: LISA E GOSSELIN
Title or Position: DIRECTOR
Credential: LNHA
Phone: 603-332-2705