Provider Demographics
NPI:1225202658
Name:CROTCHED MOUNTAIN RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:CROTCHED MOUNTAIN RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-547-3311
Mailing Address - Street 1:16 ROUTE 111
Mailing Address - Street 2:STE 3
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4142
Mailing Address - Country:US
Mailing Address - Phone:603-898-6770
Mailing Address - Fax:
Practice Address - Street 1:16 ROUTE 111
Practice Address - Street 2:STE 3
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4142
Practice Address - Country:US
Practice Address - Phone:603-898-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health