1326129966 NPI number — PENACOOK CIVIL DEFENSE RESCUE SQUAD

Table of content: (NPI 1326129966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326129966 NPI number — PENACOOK CIVIL DEFENSE RESCUE SQUAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENACOOK CIVIL DEFENSE RESCUE SQUAD
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:
PENACOOK RESCUE SQUAD
Provider Other Organization Name Type Code:
5
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:
1326129966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSCAWEN
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03303-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-753-1142
Provider Business Mailing Address Fax Number:
603-753-8792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSCAWEN
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03303-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-753-1142
Provider Business Practice Location Address Fax Number:
603-753-8792
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OBERMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
603-753-1142

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100104Y0NH01 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30010435 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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