Healthcare Provider Details

I. General information

NPI: 1942424205
Provider Name (Legal Business Name): WESTBORO HOUSE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ELM ST W
WEST LEBANON NH
03784-1609
US

IV. Provider business mailing address

11 ELM ST W
WEST LEBANON NH
03784-1609
US

V. Phone/Fax

Practice location:
  • Phone: 603-298-8326
  • Fax: 603-298-8326
Mailing address:
  • Phone: 603-298-8326
  • Fax: 603-298-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number02828
License Number StateNH

VIII. Authorized Official

Name: MRS. ANGELA J ZIZZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-298-8326