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Provider details

NPI number
Authorized official
AMELIA MICKLES (CREDENTIALING SPECIALIST)
(603) 882-3616
Entity
Organization

Contact information

Practice address
283 MAIN ST, TILTON, NH 03276-5114
(603) 286-4255
(603) 286-4256
Mailing address
77 NORTHEASTERN BLVD STE C, NASHUA, NH 03062-3128
(603) 882-3616
(603) 595-7414

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
261QR0800X
Recovery Care Clinic/Center
Primary

Other

Enumeration date
09/07/2017
Last updated
06/16/2022
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