Provider Demographics
NPI:1891908794
Name:TERRACE COMMUNITIES WINDHAM, LLC
Entity Type:Organization
Organization Name:TERRACE COMMUNITIES WINDHAM, LLC
Other - Org Name:WINDHAM TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-437-4600
Mailing Address - Street 1:3 CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087
Mailing Address - Country:US
Mailing Address - Phone:603-437-4600
Mailing Address - Fax:603-434-2228
Practice Address - Street 1:3 CHURCH RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1640
Practice Address - Country:US
Practice Address - Phone:603-437-4600
Practice Address - Fax:603-434-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02783310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH02783OtherNH LICENSE