Basic Information
| Provider Information | |||||||||
| NPI: | 1780830497 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOWN OF BRADFORD | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BRADFORD RESCUE SQUAD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PHOENIX MILL LN UNIT 200 | ||||||||
| Address2: | |||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034581445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039247797 | ||||||||
| FaxNumber: | 6038222813 | ||||||||
| Practice Location | |||||||||
| Address1: | 97 W. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032210000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039382231 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 05/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | BEHR | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6039385900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 0012 | NH | Y | Transportation Services | Ambulance |
No ID Information.