1861815094 NPI number — ENDURANCE BEHAVIORAL HEALTH PLLC

Table of content: (NPI 1861815094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861815094 NPI number — ENDURANCE BEHAVIORAL HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDURANCE BEHAVIORAL HEALTH PLLC
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:
1861815094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2899
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEABROOK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03874-2899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-918-4222
Provider Business Mailing Address Fax Number:
603-760-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 LAFAYETTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEABROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03874-4215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-760-1942
Provider Business Practice Location Address Fax Number:
603-760-1949
Provider Enumeration Date:
01/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS/MEMBER
Authorized Official Telephone Number:
603-918-4222

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  1292 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 314057 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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