Basic Information
| Provider Information | |||||||||
| NPI: | 1689668212 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SULLIVAN COUNTY COMMISSIONERS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SULLIVAN COUNTY HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NURSING HOME DRIVE | ||||||||
| Address2: | |||||||||
| City: | UNITY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037437344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035429511 | ||||||||
| FaxNumber: | 6035429214 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NURSING HOME DRIVE | ||||||||
| Address2: | |||||||||
| City: | UNITY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037437344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035429511 | ||||||||
| FaxNumber: | 6035429214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WOODMAN | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6035429511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH00088 | NH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 83016933 | 05 | NH | MEDICAID |