Provider Demographics
NPI:1699012492
Name:AMOSKEAG HEALTH
Entity Type:Organization
Organization Name:AMOSKEAG HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-626-9500
Mailing Address - Street 1:184 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2713
Mailing Address - Country:US
Mailing Address - Phone:603-626-9500
Mailing Address - Fax:603-626-0899
Practice Address - Street 1:184 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2713
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:833-448-1486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMOSKEAG HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-14
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE2627OtherMEDICARE PTAN
NH30005574Medicaid
NH301828OtherMEDICARE