Basic Information
| Provider Information | |||||||||
| NPI: | 1538437900 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREATER NASHUA COUNCIL ON ALCOHOLISM-KEYSTONE HALL | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | GREATER NASHUA COUNCIL ON ALCOHOLISM, INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038814848 | ||||||||
| FaxNumber: | 6035983644 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 AMHERST ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038814848 | ||||||||
| FaxNumber: | 6035983644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAMEL | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CLINICAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6038814848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MLADC | ||||||||
| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 0484 | NH | N | Agencies | Community/Behavioral Health | 324500000X | NH | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.