Provider Demographics
NPI:1104805613
Name:ST ANN REHABILITATION & NURSING CENTER
Entity type:Organization
Organization Name:ST ANN REHABILITATION & NURSING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:603-742-2612
Mailing Address - Street 1:195 DOVER POINT RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4612
Mailing Address - Country:US
Mailing Address - Phone:603-742-2612
Mailing Address - Fax:603-743-3055
Practice Address - Street 1:195 DOVER POINT RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4612
Practice Address - Country:US
Practice Address - Phone:603-742-2612
Practice Address - Fax:603-743-3055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HAMPSHIRE CATHOLIC CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
NH00403314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99750054Medicaid
NH305069Medicare Oscar/Certification