Basic Information
| Provider Information | |||||||||
| NPI: | 1609848811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE MENTAL HEALTH CENTER OF GREATER MANCHESTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CYPRESS STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684111 | ||||||||
| FaxNumber: | 6036287757 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 CYPRESS STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684111 | ||||||||
| FaxNumber: | 6036287757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | MICHAUD | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6036684111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPA, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 2437 | NH | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 606512 | 01 | TUFTS GROUP NUMBER | OTHER | 8PK | 01 | FEDERAL BCBS NUMBER | OTHER | 3075437 | 05 | NH | MEDICAID | 008774 | 01 | PACIFICARE GROUP NUMBER | OTHER | 289142 | 01 | MAGELLAN GROUP NUMBER | OTHER | 81263575 | 05 | NH | MEDICAID | 50NH00674NH02 | 01 | NH | LOCAL BCBS NUMBER | OTHER |