Provider Demographics
NPI:1760555064
Name:UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-237-4971
Mailing Address - Street 1:181 CORLISS LANE
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576
Mailing Address - Country:US
Mailing Address - Phone:603-237-4971
Mailing Address - Fax:603-237-4452
Practice Address - Street 1:181 CORLISS LANE
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576
Practice Address - Country:US
Practice Address - Phone:603-237-4971
Practice Address - Fax:603-237-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00592314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT301300OtherBCBS
CIGNAOther0049127
VT301300OtherVTW
5129902OtherVMC
ME138560000Medicaid
80300033OtherNHW
926356OtherMVP
RI0059200Medicaid
NH0301300OtherCAH ACUTE
301300OtherANTHEM
NH80300033Medicaid
VT301300OtherVTW
5129902OtherVMC
301300OtherANTHEM