Provider Demographics
NPI:1053319517
Name:COUNTY OF GRAFTON
Entity Type:Organization
Organization Name:COUNTY OF GRAFTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JURENTKUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-787-6971
Mailing Address - Street 1:3855 DARTMOUTH COLLEGE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVERHILL
Mailing Address - State:NH
Mailing Address - Zip Code:03774-4909
Mailing Address - Country:US
Mailing Address - Phone:603-787-6971
Mailing Address - Fax:603-787-2035
Practice Address - Street 1:3855 DARTMOUTH COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:NORTH HAVERHILL
Practice Address - State:NH
Practice Address - Zip Code:03774-4909
Practice Address - Country:US
Practice Address - Phone:603-787-6971
Practice Address - Fax:603-787-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1053319517208D00000X
NH00214314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99750025Medicaid
NH99750025Medicaid