Provider Demographics
NPI:1548317852
Name:LAKES REGION COMMUNITY SERVICES COUNCIL
Entity type:Organization
Organization Name:LAKES REGION COMMUNITY SERVICES COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-524-8811
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-0509
Mailing Address - Country:US
Mailing Address - Phone:603-524-8811
Mailing Address - Fax:603-524-0702
Practice Address - Street 1:67 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1440
Practice Address - Country:US
Practice Address - Phone:603-524-8811
Practice Address - Fax:603-524-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99560053Medicaid