Provider Demographics
NPI:1891784799
Name:COMMUNITY COUNCIL OF NASHUA, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNCIL OF NASHUA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDOCAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-465-2191
Mailing Address - Street 1:19 SOUTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6542
Mailing Address - Country:US
Mailing Address - Phone:603-465-2191
Mailing Address - Fax:603-465-9739
Practice Address - Street 1:7 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3921
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:603-883-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4716302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization