Provider Demographics
NPI:1730578741
Name:COLONIAL FOXDEN
Entity type:Organization
Organization Name:COLONIAL FOXDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-877-6333
Mailing Address - Street 1:208 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:SANDOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03873-2003
Mailing Address - Country:US
Mailing Address - Phone:603-877-6333
Mailing Address - Fax:
Practice Address - Street 1:208 NORTH RD
Practice Address - Street 2:
Practice Address - City:SANDOWN
Practice Address - State:NH
Practice Address - Zip Code:03873-2003
Practice Address - Country:US
Practice Address - Phone:603-877-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03996310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility