Basic Information
| Provider Information | |||||||||
| NPI: | 1427182286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN HUMAN SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 WASHINGTON ST | ||||||||
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| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038186044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034473347 | ||||||||
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| Practice Location | |||||||||
| Address1: | 626 EASTMAN RD | ||||||||
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| City: | CENTER CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038134219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034473347 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6034473347 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | X | Agencies | Case Management | 251C00000X | X | Agencies | Day Training, Developmentally Disabled Services | 251E00000X | X | Agencies | Home Health | 261QD1600X | X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | 320900000X | X | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 385HR2060X | X | Respite Care Facility | Respite Care | Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
ID Information
| ID | Type | State | Issuer | Description | 60000001 | 05 | NH | MEDICAID | 99590001 | 05 | NH | MEDICAID | 99590021 | 05 | NH | MEDICAID | 99590033 | 05 | NH | MEDICAID | 99560051 | 05 | NH | MEDICAID |