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General NPI Number Information
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NPI Number | 1710872494
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Entity Type | Organization
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Legal Business Name | KRE HUSKY CONCORD LICENSEE LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 300 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-2551
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Country | US
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Telephone | 603-836-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 201 JONES RD STE 300
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City | WALTHAM
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State | MA
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Zip | 02451-1618
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Country | US
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Telephone | 781-489-7100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS GRAPE
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Credential |
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Telephone | 781-489-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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