Provider Demographics
NPI:1104819606
Name:CITY OF BERLIN
Entity type:Organization
Organization Name:CITY OF BERLIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-752-1272
Mailing Address - Street 1:168 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2420
Mailing Address - Country:US
Mailing Address - Phone:603-752-1272
Mailing Address - Fax:603-752-5238
Practice Address - Street 1:168 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2420
Practice Address - Country:US
Practice Address - Phone:603-752-1272
Practice Address - Fax:603-752-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99307004Medicaid
99591037OtherHCBC
307004Medicare ID - Type Unspecified