1649581232 NPI number — ALICE PECK DAY MEMORIAL HOSPITAL

Table of content: (NPI 1649581232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649581232 NPI number — ALICE PECK DAY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALICE PECK DAY MEMORIAL HOSPITAL
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:
6
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:
1649581232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 ALICE PECK DAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766-2647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-448-3121
Provider Business Mailing Address Fax Number:
603-448-7462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 HANOVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-448-0447
Provider Business Practice Location Address Fax Number:
603-448-0019
Provider Enumeration Date:
06/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOONEY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
603-448-3121

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  11711 , 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: 1018305 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30218589 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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