Provider Demographics
NPI:1609848811
Name:THE MENTAL HEALTH CENTER OF GREATER MANCHESTER
Entity Type:Organization
Organization Name:THE MENTAL HEALTH CENTER OF GREATER MANCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DPA, MBA
Authorized Official - Phone:603-668-4111
Mailing Address - Street 1:401 CYPRESS STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:603-628-7757
Practice Address - Street 1:401 CYPRESS STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:603-628-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2437261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
606512OtherTUFTS GROUP NUMBER
8PKOtherFEDERAL BCBS NUMBER
NH3075437Medicaid
008774OtherPACIFICARE GROUP NUMBER
289142OtherMAGELLAN GROUP NUMBER
NH81263575Medicaid
NH50NH00674NH02OtherLOCAL BCBS NUMBER
NH3075437Medicaid
NH81263575Medicaid
=========OtherHEALTHCARE VALUE MGT NUMB
NH3075437Medicaid