Provider Demographics
NPI:1962070250
Name:NORTH COUNTRY INDEPENDENT LIVING INC
Entity type:Organization
Organization Name:NORTH COUNTRY INDEPENDENT LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-356-0282
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-0518
Mailing Address - Country:US
Mailing Address - Phone:603-356-0282
Mailing Address - Fax:603-356-0283
Practice Address - Street 1:2541 WHITE MOUNTAIN HWY STE 3
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5125
Practice Address - Country:US
Practice Address - Phone:603-356-0282
Practice Address - Fax:603-356-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities