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General NPI Number Information
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NPI Number | 1720281264
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Entity Type | Organization
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Legal Business Name | MOUNT PROSPECT ACADEMY, INC.
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 350 MAIN ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-4518
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Country | US
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Telephone | 603-536-1102
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Fax | 603-536-3074
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | ORFORD
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State | NH
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Zip | 03777-0325
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Country | US
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Telephone | 603-353-9102
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Fax | 603-353-9412
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY T WOLTER
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Credential |
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Telephone | 603-353-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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License Number State |
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