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333 Borthwick Ave Portsmouth NH 03801-7128 | |
| (603) 436-5110 | |
| (603) 433-5245 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 333 Borthwick Ave, Portsmouth, New Hampshire |
| Authorized Official Name and Position | Jacob Wiesmann (CFO) |
| Authorized Official Contact | 6034334010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 7004 Portsmouth NH 03802-7004 Ph: (603) 436-5110 | 333 Borthwick Ave Portsmouth NH 03801-7128 Ph: (603) 436-5110 |
| NPI Number | 1043257918 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 06/23/2022 |
| Certification Date | 06/23/2022 |
| Medicare PECOS PAC ID | 3779477005 |
|---|---|
| Medicare Enrollment ID | O20070606000457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043257918 | NPI | - | NPPES |
| 30033031 | Other | NH PSYCH PORTSMOUTH PAVIL | |
| 140140400 | Other | PORTSMOUTH PAVILION ME P |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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