Provider Demographics
NPI:1700955028
Name:NORTHERN HUMAN SERVICES
Entity Type:Organization
Organization Name:NORTHERN HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-447-3347
Mailing Address - Street 1:87 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6044
Mailing Address - Country:US
Mailing Address - Phone:603-447-3347
Mailing Address - Fax:
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6142
Practice Address - Country:US
Practice Address - Phone:603-447-3347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081387Medicaid
NH3076811Medicaid
NH3086591Medicaid
NH3072144Medicaid
NH3081392Medicaid
NH3072053Medicaid
NH3072362Medicaid
NHNH3824Medicare PIN
NHRE2816Medicare PIN
NH3072053Medicaid
NH3086591Medicaid
NH3072144Medicaid
NH81263824Medicaid
NHNH3617Medicare PIN
NH30850598Medicaid
NH99590021Medicaid