Bonfire Behavioral Health LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

BONFIRE BEHAVIORAL HEALTH LLC

Doing business as

New Hampshire Detox

Practice address

2957 Main Street
Bethlehem, NH 03574

Phone

(410) 807-8471

NPI assigned

Feb 18, 2021

Last updated

Jan 12, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kim Brown

Title

Director of Compliance

Phone

(870) 243-7219

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• New Hampshire Detox Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Bonfire Behavioral Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bonfire Behavioral Health LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Rochester, NH
  • NPI 1982081154
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol Houghton

  • Addiction (Substance Use Disorder) Counselor
  • Bethlehem, NH
  • NPI 1629502620
  NPD
• Powen Hsu, MD

  • Physical Medicine & Rehabilitation Physician
  • Concord, NH
  • NPI 1912991159
  NPD (past)
• Richard A Marasa, MD

  • Emergency Medicine Physician
  • Windsor, VT
  • NPI 1174518708
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1073106274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 MILL RUN CIR STE 810",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175549",
            "telephone_number": "410-807-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2957 MAIN STREET",
            "city": "BETHLEHEM",
            "state": "NH",
            "postal_code": "03574",
            "telephone_number": "410-807-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONFIRE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "870-243-7219"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3127887",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Hampshire Detox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rhonda L Bishop, LADC
• Rhonda Connors, RN
• Jakow Diener, M.D.
• Dr. Peter Low, DDS
• Janet Dussault
• Karen Gagne

• Substance Abuse Rehabilitation Facility in Bethlehem, NH
• Providers in Bethlehem, NH by specialty
• Substance Abuse Rehabilitation Facility in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.