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General NPI Number Information
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NPI Number | 1376756528
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Entity Type | Organization
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Legal Business Name | MALLEY FARM BOYS HOME INC.
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 250 INDIGO HILL RD
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City | SOMERSWORTH
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State | NH
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Zip | 03878-2917
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Country | US
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Telephone | 603-692-5479
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Fax | 603-692-5956
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Provider Business Mailing Address
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Address Line | 250 INDIGO HILL RD
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City | SOMERSWORTH
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State | NH
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Zip | 03878-2917
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Country | US
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Telephone | 603-692-5479
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Fax | 603-692-5956
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARK H SIPPLE
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Credential |
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Telephone | 603-692-5479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 1077
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License Number State | NH
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