Provider Demographics
NPI:1295309862
Name:STATERA BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:STATERA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-393-3233
Mailing Address - Street 1:71 ROUTE 104 UNIT 4-38
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-5731
Mailing Address - Country:US
Mailing Address - Phone:603-393-3233
Mailing Address - Fax:
Practice Address - Street 1:71 ROUTE 104 UNIT 4-38
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5731
Practice Address - Country:US
Practice Address - Phone:603-393-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)