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General NPI Number Information
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NPI Number | 1649455676
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY SERVICES GROUP HOME
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 240 N MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-5051
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Country | US
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Telephone | 603-224-9313
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Fax | 603-228-3052
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Provider Business Mailing Address
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Address Line | 240 N MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-5051
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Country | US
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Telephone | 603-224-9313
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Fax | 603-228-3052
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | EDWARD ORLOWSKI
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Credential | MSW
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Telephone | 603-224-9313
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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 | 1068
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License Number State | NH
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