Organization
VINTAGE GRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BIZEUR (DIRECTOR)
(603) 425-6339
Entity
Organization
Contact information
Practice address
12 PEABODY RD, DERRY, NH 03038-1838
(603) 425-6339
(603) 421-9367
Mailing address
12 PEABODY RD, DERRY, NH 03038-1838
(603) 425-6339
(603) 421-9367
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
251T00000X
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30009905
—
NH
05
—
30009906
—
NH
Enumeration date
03/22/2007
Last updated
05/29/2008
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