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General NPI Number Information
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NPI Number | 1295309862
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Entity Type | Organization
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Legal Business Name | STATERA BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 71 ROUTE 104 UNIT 4-38
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City | MEREDITH
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State | NH
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Zip | 03253-5731
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Country | US
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Telephone | 603-393-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 71 ROUTE 104 UNIT 4-38
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City | MEREDITH
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State | NH
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Zip | 03253-5731
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Country | US
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Telephone | 603-393-3233
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JANINE PANKER
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Credential |
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Telephone | 603-393-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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