Provider Demographics
NPI:1669658092
Name:THE FAMILY RESOURCE CENTER AT GORHAM
Entity Type:Organization
Organization Name:THE FAMILY RESOURCE CENTER AT GORHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-466-5190
Mailing Address - Street 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1659
Mailing Address - Country:US
Mailing Address - Phone:603-466-5190
Mailing Address - Fax:603-466-9022
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1659
Practice Address - Country:US
Practice Address - Phone:603-466-5190
Practice Address - Fax:603-466-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3123622Medicaid