Provider Demographics
NPI:1407266828
Name:HEADREST
Entity Type:Organization
Organization Name:HEADREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW, LCSW, MLADC
Authorized Official - Phone:603-448-4872
Mailing Address - Street 1:141 MASCOMA ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2647
Mailing Address - Country:US
Mailing Address - Phone:603-448-4872
Mailing Address - Fax:603-727-9353
Practice Address - Street 1:14 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-448-4872
Practice Address - Fax:603-448-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3105004Medicaid