Provider Demographics
NPI:1336269505
Name:UPPER VALLEY SUPPORT GROUP
Entity Type:Organization
Organization Name:UPPER VALLEY SUPPORT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:603-448-6311
Mailing Address - Street 1:12 FLYNN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1311
Mailing Address - Country:US
Mailing Address - Phone:603-448-6311
Mailing Address - Fax:
Practice Address - Street 1:12 FLYNN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1311
Practice Address - Country:US
Practice Address - Phone:603-448-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30531857251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30531857OtherI.D. PROVIDER NUMBER