Provider Demographics
NPI:1396832580
Name:THI OF NEW HAMPSHIRE AT DERRY, LLC
Entity Type:Organization
Organization Name:THI OF NEW HAMPSHIRE AT DERRY, LLC
Other - Org Name:PLEASANT VALLEY NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. CYR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-434-1566
Mailing Address - Street 1:920 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:8 PEABODY RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1807
Practice Address - Country:US
Practice Address - Phone:603-434-1566
Practice Address - Fax:603-434-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30102629Medicaid
305039Medicare Oscar/Certification