Provider Demographics
NPI:1326164971
Name:GRANITE STATE HEARING AID CENTER
Entity Type:Organization
Organization Name:GRANITE STATE HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DACHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-627-1762
Mailing Address - Street 1:25 STARK ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1935
Mailing Address - Country:US
Mailing Address - Phone:603-627-1762
Mailing Address - Fax:603-623-1299
Practice Address - Street 1:25 STARK ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1935
Practice Address - Country:US
Practice Address - Phone:603-627-1762
Practice Address - Fax:603-623-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH156332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011187Medicaid
NH30011187Medicare ID - Type UnspecifiedPROVIDER NUMBER