MEDICARE: COLONIAL FOXDEN

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	310400000X	Assisted Living Facility	03996	NH

General Provider Information

NPI Number	:	1730578741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL FOXDEN

Provider Business Mailing Address
First Line	:	208 NORTH RD
Second Line	:
City	:	SANDOWN
State	:	NH
Zip	:	03873-2003
Country	:	US
Telephone Number	:	603-877-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 NORTH RD
Second Line	:
City	:	SANDOWN
State	:	NH
Zip	:	03873-2003
Country	:	US
Telephone Number	:	603-877-6333
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARK A QUEIROS
Credential	:
Telephone Number	:	603-877-6333

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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Directions to “COLONIAL FOXDEN ” Practice Location

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