Provider Demographics
NPI:1982824900
Name:ASCENTRIA COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:ASCENTRIA COMMUNITY SERVICES, INC
Other - Org Name:LUTHERAN COMMUNITY SERVICES OF NEW HAMPSHIRE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-243-3900
Mailing Address - Street 1:261 SHEEP DAVIS ROAD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-224-8111
Mailing Address - Fax:603-224-0798
Practice Address - Street 1:261 SHEEP DAVIS ROAD
Practice Address - Street 2:SUITE A-1
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-224-8111
Practice Address - Fax:603-224-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2487322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30831996Medicaid