Provider Demographics
NPI:1508443037
Name:WHITE MOUNTAINS RECOVERY CENTERS LLC
Entity Type:Organization
Organization Name:WHITE MOUNTAINS RECOVERY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-326-2913
Mailing Address - Street 1:669 UNION ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-5350
Mailing Address - Country:US
Mailing Address - Phone:508-326-2913
Mailing Address - Fax:
Practice Address - Street 1:11 CROSS ST # 1
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4900
Practice Address - Country:US
Practice Address - Phone:508-326-2913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder