Provider Demographics
NPI: | 1750543013 |
---|---|
Name: | ELLIOT HOSPITAL |
Entity type: | Organization |
Organization Name: | ELLIOT HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIR OF PATIENT FINANCIAL SERV |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OCONNOR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 603-663-2431 |
Mailing Address - Street 1: | 1 ELLIOT WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | MANCHESTER |
Mailing Address - State: | NH |
Mailing Address - Zip Code: | 03103-3502 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-663-2431 |
Mailing Address - Fax: | 603-663-5820 |
Practice Address - Street 1: | 1070 HOLT AVE |
Practice Address - Street 2: | |
Practice Address - City: | MANCHESTER |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03109-5603 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-663-2448 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-27 |
Last Update Date: | 2008-06-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 30591426 | Medicaid | |
NH | 30582440 | Medicaid |