Provider Demographics
NPI:1467436089
Name:GOODWIN COMMUNITY HEALTH
Entity Type:Organization
Organization Name:GOODWIN COMMUNITY HEALTH
Other - Org Name:AVIS GOODWIN COMMUNITY HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-956-0063
Mailing Address - Street 1:311 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1522
Mailing Address - Country:US
Mailing Address - Phone:603-749-2346
Mailing Address - Fax:603-953-0066
Practice Address - Street 1:311 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1522
Practice Address - Country:US
Practice Address - Phone:603-749-2346
Practice Address - Fax:603-953-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X
NH261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011038Medicaid
ME138790101OtherMAINECARE FFS
NH30312977OtherDENTAL MEDICAID
ME138790200OtherMAINE CARE
ME99909035OtherME MEDICAID PRIMECARE
NH30312977OtherDENTAL MEDICAID
NH301810Medicare Oscar/Certification