Provider Demographics
NPI:1114518974
Name:MONADNOCK WORKSOURCE INCORPORATED
Entity Type:Organization
Organization Name:MONADNOCK WORKSOURCE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-924-3326
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-0028
Mailing Address - Country:US
Mailing Address - Phone:603-924-3326
Mailing Address - Fax:603-924-3328
Practice Address - Street 1:9 VOSE FARM RD STE 150
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2155
Practice Address - Country:US
Practice Address - Phone:603-924-3326
Practice Address - Fax:603-924-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities