Provider Demographics
NPI:1346543527
Name:GRACE HOUSE OF WINDHAM
Entity Type:Organization
Organization Name:GRACE HOUSE OF WINDHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-889-1800
Mailing Address - Street 1:23 MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1773
Mailing Address - Country:US
Mailing Address - Phone:603-889-1800
Mailing Address - Fax:603-943-5357
Practice Address - Street 1:23 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1773
Practice Address - Country:US
Practice Address - Phone:603-889-1800
Practice Address - Fax:603-943-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03498310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility