1619372356 NPI number — ADVANCED BEHAVIORAL HEALTHCARE SERVICES OF NH, INC.

Table of content: (NPI 1619372356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619372356 NPI number — ADVANCED BEHAVIORAL HEALTHCARE SERVICES OF NH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED BEHAVIORAL HEALTHCARE SERVICES OF NH, INC.
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:
1619372356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03064-2614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-0005
Provider Business Mailing Address Fax Number:
603-883-0007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03064-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-883-0005
Provider Business Practice Location Address Fax Number:
603-883-0007
Provider Enumeration Date:
10/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWALD
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-883-0005

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1077 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 477 , 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)





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