Provider Demographics
NPI:1881257590
Name:CHESHIRE MEDICAL CENTER
Entity type:Organization
Organization Name:CHESHIRE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-354-5400
Mailing Address - Street 1:640 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4049
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder