Betty C Ketchum Foundation

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

BETTY C KETCHUM FOUNDATION

Practice address

987 E Main St
Center Conway, NH 03813-4215

Phone

(603) 356-4980

Fax

(603) 356-4918

NPI assigned

Aug 19, 2020

Organization subpart

No

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

Authorized official

Name

Susan M Ruka

Title

Administrator

Phone

(603) 356-4980

Specialties & licenses 1

Addresses

Other names 1

• Mount Washington Valley Adult Day Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sohaib Siddiqui, MD

  • Family Medicine Physician
  • Conway, NH
  • NPI 1073712725
  Medicare reassignment NPD

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1861004053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 E MAIN ST",
            "city": "CENTER CONWAY",
            "state": "NH",
            "postal_code": "038134215",
            "telephone_number": "603-356-4980",
            "fax_number": "603-356-4918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 E MAIN ST",
            "city": "CENTER CONWAY",
            "state": "NH",
            "postal_code": "038134215",
            "telephone_number": "603-356-4980",
            "fax_number": "603-356-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETTY C KETCHUM FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "RUKA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "603-356-4980"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Washington Valley Adult Day Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Austin Medical Products
• Donald Boulet
• Chad Boxall
• Quinn Coleman
• Compass Children'S Clinic
• Adam Fredrick Cook, PHARMD

• Adult Day Care Clinic/Center in Center Conway, NH
• Providers in Center Conway, NH by specialty
• Adult Day Care Clinic/Center in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.