1275672057 NPI number — MONADNOCK DEVELOPMENTAL SERVICES

Table of content: (NPI 1275672057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275672057 NPI number — MONADNOCK DEVELOPMENTAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONADNOCK DEVELOPMENTAL SERVICES
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:
1275672057
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:
121 RAILROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEENE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03431-3747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-352-1304
Provider Business Mailing Address Fax Number:
603-352-1637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-352-1304
Provider Business Practice Location Address Fax Number:
603-352-1637
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
603-352-1304

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 60000005 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30593003 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99560015 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30010579 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99590025 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99590005 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99560055 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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