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General NPI Number Information
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NPI Number | 1285313643
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Entity Type | Organization
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Legal Business Name | MVTC, LLC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 703 RIVER RD
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City | PLAINFIELD
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State | NH
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Zip | 03781-5044
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Country | US
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Telephone | 603-989-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 703 RIVER RD
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City | PLAINFIELD
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State | NH
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Zip | 03781-5044
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Country | US
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Telephone | 603-989-3500
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Fax |
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS AND ENROLLMENT
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Name | ADRIAN EVERETT LOGAN
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Credential | MA, GC
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Telephone | 603-989-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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