Provider Demographics
NPI:1235245390
Name:HANOVER HILL HEALTH CARE CENTER SERVICES INC.
Entity Type:Organization
Organization Name:HANOVER HILL HEALTH CARE CENTER SERVICES INC.
Other - Org Name:HANOVER HILL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-627-3826
Mailing Address - Street 1:700 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5309
Mailing Address - Country:US
Mailing Address - Phone:603-627-3826
Mailing Address - Fax:603-668-5240
Practice Address - Street 1:700 HANOVER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-5309
Practice Address - Country:US
Practice Address - Phone:603-627-3826
Practice Address - Fax:603-668-5240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANOVER HILL NURSING HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00590313M00000X, 314000000X
NH03562313M00000X, 314000000X
NH0651830001332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30597706Medicaid
NH80305009Medicaid
NH30107722Medicaid
NH30107722Medicaid