Provider Demographics
NPI:1457568180
Name:MYRTLE MANOR II, INC.
Entity Type:Organization
Organization Name:MYRTLE MANOR II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:DUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-641-6626
Mailing Address - Street 1:83 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6018
Mailing Address - Country:US
Mailing Address - Phone:603-641-6626
Mailing Address - Fax:603-641-6678
Practice Address - Street 1:83 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-6018
Practice Address - Country:US
Practice Address - Phone:603-641-6626
Practice Address - Fax:603-641-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02233310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility