=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770684672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NEW LONDON HOSPITAL ASSOCIATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 JOHN STARK HWY
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-526-5167
-----------------------------------------------------
Fax | 603-526-5085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 JOHN STARK HWY
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-526-5167
-----------------------------------------------------
Fax | 603-526-5085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LISA COHEN
-----------------------------------------------------
Credential | LISA COHEN
-----------------------------------------------------
Telephone | 603-526-5372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 02132
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------