Provider Demographics
NPI:1477569234
Name:NEW CREATION HEALING CENTER, INC
Entity Type:Organization
Organization Name:NEW CREATION HEALING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-642-6700
Mailing Address - Street 1:80 ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3535
Mailing Address - Country:US
Mailing Address - Phone:603-642-6700
Mailing Address - Fax:603-642-6701
Practice Address - Street 1:80 ROUTE 125
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3535
Practice Address - Country:US
Practice Address - Phone:603-642-6700
Practice Address - Fax:603-642-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30900090Medicaid
MA9785515Medicaid
MABCBSOtherM17086
MATUFTSOther681554
NHHEALTHSOURCEOther15221
NH30900090Medicaid