Provider Demographics
NPI:1124144084
Name:NASHUA CENTER FOR THE MULTIPLY HANDICAPPED, INC.
Entity type:Organization
Organization Name:NASHUA CENTER FOR THE MULTIPLY HANDICAPPED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:603-883-6163
Mailing Address - Street 1:18 SIMON ST
Mailing Address - Street 2:P O BOX 1269
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3009
Mailing Address - Country:US
Mailing Address - Phone:603-883-6163
Mailing Address - Fax:603-881-7198
Practice Address - Street 1:18 SIMON ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3009
Practice Address - Country:US
Practice Address - Phone:603-883-6163
Practice Address - Fax:603-881-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03090251E00000X, 253Z00000X
NH70557251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30593962Medicaid