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General NPI Number Information
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NPI Number | 1891784799
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNCIL OF NASHUA, INC.
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 PROSPECT ST
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City | NASHUA
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State | NH
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Zip | 03060-3921
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Country | US
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Telephone | 603-889-6147
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Fax | 603-883-1568
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Provider Business Mailing Address
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Address Line | 19 SOUTHGATE RD
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City | HOLLIS
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State | NH
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Zip | 03049-6542
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Country | US
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Telephone | 603-465-2191
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Fax | 603-465-9739
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Authorized Official
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Title or Position | MEDOCAL DIRECTOR
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Name | DR. JEUNG H SOHN
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Credential | M.D.
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Telephone | 603-465-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 4716
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License Number State | NH
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