Provider Demographics
NPI:1992750764
Name:CFN MANCHESTER NORTH LLC
Entity type:Organization
Organization Name:CFN MANCHESTER NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-459-6094
Mailing Address - Street 1:901 SUNCOOK VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:EPSOM
Mailing Address - State:NH
Mailing Address - Zip Code:03234-4329
Mailing Address - Country:US
Mailing Address - Phone:603-736-4772
Mailing Address - Fax:
Practice Address - Street 1:901 SUNCOOK VALLEY HWY
Practice Address - Street 2:
Practice Address - City:EPSOM
Practice Address - State:NH
Practice Address - Zip Code:03234-4329
Practice Address - Country:US
Practice Address - Phone:603-736-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDERTRUST OF FLORIDA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02854314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30101898Medicaid
NH0305080OtherBC BS NH
NH0305080OtherBC BS NH