Provider Demographics
NPI:1649455676
Name:CHILD AND FAMILY SERVICES GROUP HOME
Entity type:Organization
Organization Name:CHILD AND FAMILY SERVICES GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:603-224-9313
Mailing Address - Street 1:240 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5051
Mailing Address - Country:US
Mailing Address - Phone:603-224-9313
Mailing Address - Fax:603-228-3052
Practice Address - Street 1:240 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5051
Practice Address - Country:US
Practice Address - Phone:603-224-9313
Practice Address - Fax:603-228-3052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD AND FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1068322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children