Provider Demographics
NPI:1881040905
Name:CONNELLY, GAGNE & PRUSSEL, INC.
Entity Type:Organization
Organization Name:CONNELLY, GAGNE & PRUSSEL, INC.
Other - Org Name:ADULT DAY CARE OF NASHUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRUSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-689-8818
Mailing Address - Street 1:460 AMHERST ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1220
Mailing Address - Country:US
Mailing Address - Phone:603-589-9570
Mailing Address - Fax:603-589-9567
Practice Address - Street 1:460 AMHERST ST
Practice Address - Street 2:SUITE #4
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1220
Practice Address - Country:US
Practice Address - Phone:603-589-9570
Practice Address - Fax:603-589-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03872261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care