Basic Information
| Provider Information | |||||||||
| NPI: | 1861048969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMOSKEAG HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 HOLLIS ST | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066269500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1555 ELM ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031011203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036269500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2019 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCRACKEN | ||||||||
| AuthorizedOfficialFirstName: | KRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 6036269500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.