Provider Demographics
NPI:1750784807
Name:191 HACKETT HILL ROAD OPERATIONS LLC
Entity type:Organization
Organization Name:191 HACKETT HILL ROAD OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVITORRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-444-6340
Mailing Address - Street 1:191 HACKETT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8993
Mailing Address - Country:US
Mailing Address - Phone:603-668-8181
Mailing Address - Fax:603-668-8162
Practice Address - Street 1:191 HACKETT HILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-8993
Practice Address - Country:US
Practice Address - Phone:603-668-8181
Practice Address - Fax:603-668-8162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS NH HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01466314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility