Provider Demographics
NPI:1942424205
Name:WESTBORO HOUSE INCORPORATED
Entity Type:Organization
Organization Name:WESTBORO HOUSE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZIZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-298-8326
Mailing Address - Street 1:11 ELM ST W
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1609
Mailing Address - Country:US
Mailing Address - Phone:603-298-8326
Mailing Address - Fax:603-298-8326
Practice Address - Street 1:11 ELM ST W
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1609
Practice Address - Country:US
Practice Address - Phone:603-298-8326
Practice Address - Fax:603-298-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02828310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30592069Medicaid