Provider Demographics
NPI:1275672057
Name:MONADNOCK DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:MONADNOCK DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-352-1304
Mailing Address - Street 1:121 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3747
Mailing Address - Country:US
Mailing Address - Phone:603-352-1304
Mailing Address - Fax:603-352-1637
Practice Address - Street 1:121 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3747
Practice Address - Country:US
Practice Address - Phone:603-352-1304
Practice Address - Fax:603-352-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251V00000XAgenciesVoluntary or Charitable
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH60000005Medicaid
NH30593003Medicaid
NH99560015Medicaid
NH30010579Medicaid
NH99590025Medicaid
NH99590005Medicaid
NH99560055Medicaid