1609848811 NPI number — THE MENTAL HEALTH CENTER OF GREATER MANCHESTER

Table of content: (NPI 1609848811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609848811 NPI number — THE MENTAL HEALTH CENTER OF GREATER MANCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MENTAL HEALTH CENTER OF GREATER MANCHESTER
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:
1609848811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 CYPRESS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-4111
Provider Business Mailing Address Fax Number:
603-628-7757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 CYPRESS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-668-4111
Provider Business Practice Location Address Fax Number:
603-628-7757
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MICHAUD
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
603-668-4111

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  2437 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 606512 . This is a "TUFTS GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8PK . This is a "FEDERAL BCBS NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3075437 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008774 . This is a "PACIFICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 289142 . This is a "MAGELLAN GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81263575 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50NH00674NH02 . This is a "LOCAL BCBS NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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