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General NPI Number Information
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NPI Number | 1669643300
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Entity Type | Organization
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Legal Business Name | BRAIN INJURY ASSOCIATION OF NH
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 109 N STATE ST
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City | CONCORD
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State | NH
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Zip | 03301-4358
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Country | US
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Telephone | 603-225-8400
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Fax | 603-228-6749
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Provider Business Mailing Address
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Address Line | 109 N STATE ST
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City | CONCORD
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State | NH
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Zip | 03301-4358
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Country | US
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Telephone | 603-225-8400
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Fax | 603-228-6749
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. STEVEN WADE
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Credential | MBA
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Telephone | 603-225-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 03055
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License Number State | NH
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