Provider Demographics
NPI:1326027830
Name:ST VINCENT REHABILITATION & NURSING CENTER
Entity Type:Organization
Organization Name:ST VINCENT REHABILITATION & NURSING CENTER
Other - Org Name:ST. VINCENT DEPAUL REHABILITATION & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DINGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:603-752-1820
Mailing Address - Street 1:29 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3130
Mailing Address - Country:US
Mailing Address - Phone:603-752-1820
Mailing Address - Fax:603-752-7149
Practice Address - Street 1:29 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3130
Practice Address - Country:US
Practice Address - Phone:603-752-1820
Practice Address - Fax:603-752-7149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HAMPSHIRE CATHOLIC CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00503314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99750057Medicaid
NH305066Medicare Oscar/Certification