Provider Demographics
NPI:1215166962
Name:COMMUNITY SERVICES COUNCIL OF NH
Entity type:Organization
Organization Name:COMMUNITY SERVICES COUNCIL OF NH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-225-9694
Mailing Address - Street 1:PO BOX 2338
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-2338
Mailing Address - Country:US
Mailing Address - Phone:603-225-9694
Mailing Address - Fax:603-225-3773
Practice Address - Street 1:79 SHEEP DAVIS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-3714
Practice Address - Country:US
Practice Address - Phone:603-225-9694
Practice Address - Fax:603-225-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03399261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30596945Medicaid