1750610598 NPI number — CHERYL DOUCETTE ANP BC PMHCNS BC LLC

Table of content: (NPI 1750610598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750610598 NPI number — CHERYL DOUCETTE ANP BC PMHCNS BC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERYL DOUCETTE ANP BC PMHCNS BC LLC
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:
1750610598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WOODSTOCK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03262-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-728-8872
Provider Business Mailing Address Fax Number:
603-945-8991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 MOUNTAIN PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03262-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-728-8872
Provider Business Practice Location Address Fax Number:
603-745-7089
Provider Enumeration Date:
12/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DOUCETTE
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER, MANAGER
Authorized Official Telephone Number:
603-728-8872

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1316969611 . This is a "PROVIDER NPI" identifier . This identifiers is of the category "OTHER".




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