Provider Demographics
NPI:1740061340
Name:B AND G COMMON ACTIONS FOR CHANGE
Entity type:Organization
Organization Name:B AND G COMMON ACTIONS FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIENFAIT
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-512-1942
Mailing Address - Street 1:89 SUMMERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4929
Mailing Address - Country:US
Mailing Address - Phone:603-512-1942
Mailing Address - Fax:
Practice Address - Street 1:86 A ST APT 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4714
Practice Address - Country:US
Practice Address - Phone:603-262-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty