Provider Demographics
NPI:1801359302
Name:ANDROSCOGGIN VALLEY HOSPITAL, INC.
Entity Type:Organization
Organization Name:ANDROSCOGGIN VALLEY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVH SR. DIRECTOR, MED STAFF OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPCO
Authorized Official - Phone:603-326-5608
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3531
Mailing Address - Country:US
Mailing Address - Phone:603-752-2200
Mailing Address - Fax:603-752-1836
Practice Address - Street 1:7 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDROSCOGGIN VALLEY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health