1528248325 NPI number — ELLIOT ADULT DAY CARE

Table of content: (NPI 1528248325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528248325 NPI number — ELLIOT ADULT DAY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLIOT ADULT DAY CARE
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:
1528248325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 HOLT AVE
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:
03109-5603
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:
1070 HOLT AVE
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:
03109-5603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-663-2431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNOR
Authorized Official First Name:
JAMES O'CONNOR
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PATIENT FINANCIAL SERV
Authorized Official Telephone Number:
603-663-2431

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  03287 , 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: 30592535 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30582440 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com