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General NPI Number Information
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NPI Number | 1962070250
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY INDEPENDENT LIVING INC
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 2541 WHITE MOUNTAIN HWY STE 3
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City | NORTH CONWAY
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State | NH
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Zip | 03860-5125
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Country | US
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Telephone | 603-356-0282
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Fax | 603-356-0283
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Provider Business Mailing Address
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Address Line | PO BOX 518
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City | NORTH CONWAY
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State | NH
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Zip | 03860-0518
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Country | US
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Telephone | 603-356-0282
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Fax | 603-356-0283
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | GARRY SHERRY
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Credential |
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Telephone | 603-356-0282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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