Healthcare Provider Details

I. General information

NPI: 1831420074
Provider Name (Legal Business Name): COPP HILL RESIDENTIAL HOME FRO ELDERLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 COPP HILL RD
SANBORNVILLE NH
03872
US

IV. Provider business mailing address

176 COPP HILL RD
SANBORNVILLE NH
03872-4700
US

V. Phone/Fax

Practice location:
  • Phone: 603-473-8908
  • Fax: 603-473-8456
Mailing address:
  • Phone: 603-473-8908
  • Fax: 603-473-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number03543
License Number StateNH

VIII. Authorized Official

Name: CHERYL LYNN DODDRELL
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 603-473-8908