Provider Demographics
NPI:1932445186
Name:COMMUNITY COUNCIL OF NASHUA NH
Entity Type:Organization
Organization Name:COMMUNITY COUNCIL OF NASHUA NH
Other - Org Name:RESEARCH CENTER AT GREATER NASHUA MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAFEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-889-6147
Mailing Address - Street 1:7 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3921
Mailing Address - Country:US
Mailing Address - Phone:603-889-6147
Mailing Address - Fax:603-883-1568
Practice Address - Street 1:7 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3921
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:603-883-1568
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY COUNCIL OF NASHUA NH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30D0995846291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30D0995846OtherCLIA