Healthcare Provider Details

I. General information

NPI: 1558085605
Provider Name (Legal Business Name): FOUR WINDS COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 GIBBONS HIGHWAY
WILTON NH
03086
US

IV. Provider business mailing address

32 COLBURN ROAD
TEMPLE NH
03084-4307
US

V. Phone/Fax

Practice location:
  • Phone: 603-878-2325
  • Fax: 603-878-4388
Mailing address:
  • Phone: 603-878-2325
  • Fax: 603-878-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PAUL MARTIN
Title or Position: PRESIDENT
Credential:
Phone: 603-878-2325