Organization
PINE HAVEN BOYS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN B. VITALI (EXECUTIVE DIRECTOR)
(603) 485-7141
Entity
Organization
Contact information
Practice address
133 RIVER RD, ALLENSTOWN, NH 03275-2362
(603) 485-7141
(603) 485-7142
Mailing address
133 RIVER RD, PO BOX 162, ALLENSTOWN, NH 03275-2362
(603) 485-7141
(603) 485-7142
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
1073
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30007076
—
NH
Enumeration date
04/18/2007
Last updated
08/22/2020
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