Provider Demographics
NPI:1891944096
Name:ANDROSCOGGIN VALLEY HOSPITAL
Entity Type:Organization
Organization Name:ANDROSCOGGIN VALLEY HOSPITAL
Other - Org Name:HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-326-5601
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:603-752-2300
Mailing Address - Fax:603-326-5999
Practice Address - Street 1:59 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:603-326-5999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDROSCOGGIN VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002625Medicaid
NH30002625Medicaid