1235331208 NPI number — FULCRUM BEHAVIORAL CONSULTANTS LTD

Table of content: (NPI 1235331208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235331208 NPI number — FULCRUM BEHAVIORAL CONSULTANTS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULCRUM BEHAVIORAL CONSULTANTS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235331208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
734 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03246-2777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
734 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-528-5968
Provider Business Practice Location Address Fax Number:
603-528-3348
Provider Enumeration Date:
06/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLBY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-528-5968

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  736 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X , with the licence number: 736 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X , with the licence number: 736 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30852367 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52256 . This is a "STATE OF NEW HAMPSHIRE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".