Provider Demographics
NPI:1619141165
Name:THE GRAPEVINE FAMILY & COMMUNITY RESOURCE CENTER
Entity Type:Organization
Organization Name:THE GRAPEVINE FAMILY & COMMUNITY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:603-588-2620
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ANTRIM
Mailing Address - State:NH
Mailing Address - Zip Code:03440-0637
Mailing Address - Country:US
Mailing Address - Phone:603-588-2620
Mailing Address - Fax:603-588-7154
Practice Address - Street 1:4 AIKEN STREET
Practice Address - Street 2:
Practice Address - City:ANTRIM
Practice Address - State:NH
Practice Address - Zip Code:03440
Practice Address - Country:US
Practice Address - Phone:603-588-2620
Practice Address - Fax:603-588-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30852845251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health