Provider Demographics
NPI:1134125040
Name:COUNTY OF MERRIMACK
Entity Type:Organization
Organization Name:COUNTY OF MERRIMACK
Other - Org Name:MERRIMACK COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIBINETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MBA,NHA
Authorized Official - Phone:603-796-2165
Mailing Address - Street 1:325 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:BOSCAWEN
Mailing Address - State:NH
Mailing Address - Zip Code:03303-2410
Mailing Address - Country:US
Mailing Address - Phone:603-796-2165
Mailing Address - Fax:603-796-3269
Practice Address - Street 1:325 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:BOSCAWEN
Practice Address - State:NH
Practice Address - Zip Code:03303-2410
Practice Address - Country:US
Practice Address - Phone:603-796-2165
Practice Address - Fax:603-796-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
NH03351314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5BTOtherANTHEM BLUE CROSS BLUE SHIELD
NHRE6251OtherNGS
NH3078723Medicaid
NH3071571Medicaid
NH305056Medicare Oscar/Certification