Provider Demographics
NPI:1104497767
Name:LEGACY BY GERSH AT CROTCHED MOUNTAIN LLC
Entity type:Organization
Organization Name:LEGACY BY GERSH AT CROTCHED MOUNTAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-523-9981
Mailing Address - Street 1:1 VERNEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03047-5000
Mailing Address - Country:US
Mailing Address - Phone:603-547-3311
Mailing Address - Fax:603-547-2072
Practice Address - Street 1:1 VERNEY DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03047-5000
Practice Address - Country:US
Practice Address - Phone:603-547-3311
Practice Address - Fax:603-547-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent HealthGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty