Provider Demographics
NPI:1669643300
Name:BRAIN INJURY ASSOCIATION OF NH
Entity Type:Organization
Organization Name:BRAIN INJURY ASSOCIATION OF NH
Other - Org Name:NATIONAL HEAD INJURY FOUNDATION NH CHAPTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:603-225-8400
Mailing Address - Street 1:109 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4358
Mailing Address - Country:US
Mailing Address - Phone:603-225-8400
Mailing Address - Fax:603-228-6749
Practice Address - Street 1:109 N STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4358
Practice Address - Country:US
Practice Address - Phone:603-225-8400
Practice Address - Fax:603-228-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03055251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management