Provider Demographics
NPI:1386969954
Name:CHILD HEALTH SERVICES
Entity type:Organization
Organization Name:CHILD HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBRIGIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-668-6629
Mailing Address - Street 1:1245 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1308
Mailing Address - Country:US
Mailing Address - Phone:603-668-6629
Mailing Address - Fax:603-622-7680
Practice Address - Street 1:1245 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1308
Practice Address - Country:US
Practice Address - Phone:603-668-6629
Practice Address - Fax:603-622-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0767302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization