Healthcare Provider Details

I. General information

NPI: 1750755450
Provider Name (Legal Business Name): JILL THERESA DANEAULT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WHITEHALL RD
ROCHESTER NH
03867-3225
US

IV. Provider business mailing address

40 WHITEHALL RD
ROCHESTER NH
03867-3225
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-7711
  • Fax:
Mailing address:
  • Phone: 603-332-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0420
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: