Provider Demographics
NPI:1770684672
Name:THE NEW LONDON HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:THE NEW LONDON HOSPITAL ASSOCIATION, INC.
Other - Org Name:NEWPORT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIERAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-526-5203
Mailing Address - Street 1:11 JOHN STARK HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773
Mailing Address - Country:US
Mailing Address - Phone:603-526-5167
Mailing Address - Fax:603-526-5085
Practice Address - Street 1:11 JOHN STARK HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773
Practice Address - Country:US
Practice Address - Phone:603-526-5167
Practice Address - Fax:603-526-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
NH02132261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH70001001Medicaid
NH70001001Medicaid
NH303978Medicare Oscar/Certification