Basic Information
| Provider Information | |||||||||
| NPI: | 1891784799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY COUNCIL OF NASHUA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 SOUTHGATE RD | ||||||||
| Address2: | |||||||||
| City: | HOLLIS | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030496542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034652191 | ||||||||
| FaxNumber: | 6034659739 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038896147 | ||||||||
| FaxNumber: | 6038831568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SOHN | ||||||||
| AuthorizedOfficialFirstName: | JEUNG | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDOCAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6034652191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 4716 | NH | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.