Provider Demographics
NPI:1720179898
Name:COLONIAL POPLIN NURSING HOME, INC.
Entity Type:Organization
Organization Name:COLONIAL POPLIN NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:603-895-3126
Mailing Address - Street 1:P. O. BOX 101
Mailing Address - Street 2:442 MAIN ST
Mailing Address - City:FREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03044-3434
Mailing Address - Country:US
Mailing Address - Phone:603-895-3126
Mailing Address - Fax:603-895-3662
Practice Address - Street 1:442 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NH
Practice Address - Zip Code:03044-3434
Practice Address - Country:US
Practice Address - Phone:603-895-3126
Practice Address - Fax:603-895-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02393314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3009862Medicaid
NH30009862Medicaid
NH305091Medicare Oscar/Certification