Healthcare Provider Details

I. General information

NPI: 1376738096
Provider Name (Legal Business Name): AMMONOOSUC COMMUNITY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RAILROAD ST
WOODSVILLE NH
03785-1118
US

IV. Provider business mailing address

25 MOUNT EUSTIS RD
LITTLETON NH
03561-3712
US

V. Phone/Fax

Practice location:
  • Phone: 603-747-3990
  • Fax: 603-444-3441
Mailing address:
  • Phone: 603-444-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: MR. EDWARD D SHANSHALA II
Title or Position: DIRECTOR
Credential:
Phone: 603-444-2464