MEDICARE: COUNTY OF GRAFTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	1053319517	NH
2	314000000X	Skilled Nursing Facility	00214	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053319517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF GRAFTON

Provider Business Mailing Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-6971
Fax Number	:	603-787-2035

Provider Business Practice Location Address
First Line	:	3855 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-6971
Fax Number	:	603-787-2035

Authorized Official
Title or Position	:	CFO
Name	:	DAWN L JURENTKUFF
Credential	:
Telephone Number	:	603-787-6971

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	11/01/2019

Similar Medicare Providers

1760539449 — DR. LINDA SUZETTE DEFRAHN D.O.
Practice Location Address:

3855 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL, NH
03774-4909

Practice Phone: 603-787-6971
Practice Fax: 603-787-2035

1538401401 — NICOLE LYN MITCHELL LADC
Practice Location Address:

3801 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL, NH
03774-4909

Practice Phone: 603-787-2042
Practice Fax: 603-787-2044

1346604469 — GRAFTON COUNTY
Practice Location Address:

3801 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL, NH
03774-4909

Practice Phone: 603-787-2042
Practice Fax:

1023871787 — CASSIE ELIZABETH MANNING B.S, LADC
Practice Location Address:

3801 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL, NH
03774-4909

Practice Phone: 603-787-2042
Practice Fax:

1417906496 — MRS. LILI CARGILL ARNP
Practice Location Address:

3855 DARTMOUTH COLLEGE HWY
NORTH HAVERHILL, NH
03774-4937

Practice Phone: 603-787-6971
Practice Fax: 603-787-2012

1881637379 — MS. MARIE LOUISE FRANCIS PT
Practice Location Address:

85 SINCLAIR RD
NORTH HAVERHILL, NH
03774-5963

Practice Phone: 603-787-9000
Practice Fax: 603-787-9999

Directions to “COUNTY OF GRAFTON ” Practice Location

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