Provider Demographics
NPI:1285798090
Name:NEW HAMPSHIRE ODD FELLOWS HOME
Entity type:Organization
Organization Name:NEW HAMPSHIRE ODD FELLOWS HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-724-6161
Mailing Address - Street 1:200 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2505
Mailing Address - Country:US
Mailing Address - Phone:603-225-6644
Mailing Address - Fax:603-226-2198
Practice Address - Street 1:200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2505
Practice Address - Country:US
Practice Address - Phone:603-225-6644
Practice Address - Fax:603-226-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1817314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99750047Medicaid
NH305063Medicare ID - Type Unspecified