1760559892 NPI number — CENTER FOR NEW BEGINNINGS

Table of content: (NPI 1760559892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760559892 NPI number — CENTER FOR NEW BEGINNINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR NEW BEGINNINGS
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:
1760559892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 COTTAGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03561-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-444-6465
Provider Business Mailing Address Fax Number:
603-444-6233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 COTTAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03561-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-444-6465
Provider Business Practice Location Address Fax Number:
603-444-6233
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOUCHARD
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
603-444-6465

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1051693 . This is a "CIGNA GROUP NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 39547 . This is a "BCBS OF VT GROUP NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 39549 . This is a "BCBS OF VT GROUP NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1006586 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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