Ammonoosuc Community Health Services, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Warren, NH
NPI 1982821765 · NPPES record last updated Mar 16, 2009
Key facts
- NPI
- 1982821765
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- AMMONOOSUC COMMUNITY HEALTH SERVICES, INC
- Practice address
- 333 Nhroute 25
Warren, NH 03279-4431 - Phone
- (603) 764-5704
- NPI assigned
- Apr 20, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- AMMONOOSUC COMMUNITY HEALTH SERVICES, INC
Authorized official
- Name
- Mr. Edward D Shanshala II
- Title
- Director
- Phone
- (603) 444-2464
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 6
Practitioners 28
-
David V Ferris, DO
-
Elizabeth J Harrington, APRN
-
Stephen M Noyes, MSW
-
Judith P Santy, LICSW
-
Aaron Solnit, M.D.
-
Colleen Marie Sullivan, RN/NP
-
Sarah Young-Xu, M.D.
-
Lili Cargill, ARNP
-
Katrina L Colby, APRN
-
Pamela Woodburn Comeau, PMHNP-BC
-
Julie Lynn Ferland, APRN
-
Nicole V Fischler, APRN
-
Linne Marie Humbargar, PA-C
-
Benson Edward Kenney-Canfield, DNP, FNP-C
-
Laura Mack, MA, LADC, LCMHC
-
Ian Chase Parker, D.O.
-
Kathleen J Smith, M.D.
-
Keri Stiles, APRN
-
Brian Lawrence Espe, LCSW
-
Marina Tamlin Partridge, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NH
Federally qualified health center certification: CCN 301806
- Legal name
- AMMONOOSUC COMMUNITY HEALTH SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 1, 1995
- Last certification
- Jul 1, 1995
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 24, 1975 in NH
- Enrollment address
- 333 NH Route 25
Warren, NH 32794431
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Secord |
Corporate Director |
Jul 1, 2012 | |
| Edward Shanshala |
Corporate Officer |
Oct 1, 2008 | |
| W-2 Managing Employee |
Oct 1, 2008 | ||
| Operational/Managerial Control |
Oct 1, 2008 | ||
| Robert Tortorice |
Corporate Director | Dec 10, 2008 | |
| John Rapoport |
Corporate Director |
Jul 1, 2014 | |
| Elizabeth F Harman |
Corporate Director |
Jan 1, 2015 | |
| Gary Merchant |
Corporate Director |
Jan 1, 2016 | |
| Edward Densmore |
Corporate Director |
Jul 1, 2012 | |
| Erik Becker |
Corporate Director |
Jan 1, 2017 | |
| Kenneth Riebel |
Corporate Officer |
Feb 22, 2008 | |
| W-2 Managing Employee |
Feb 22, 2008 | ||
| Ivy Pearon |
Corporate Director |
Jan 1, 2017 | |
| Doug Harman |
Corporate Director |
Jul 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080228000543 | NH | Part a Provider - Federally Qualified Health Center (FQHC) | 1052361664 | Practice locations: Warren, NH |
National Provider Directory
- Tax ID family
- Ammonoosuc Community He
- Part of
- Ammonoosuc Community He
Locations
14 King Sq
Whitefield, NH 03598
Phone (603) 837-2333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
333 Nhroute 25
Warren, NH 03279-4431
Mailing address
25 Mount Eustis Rd
Littleton, NH 03561-3712
Phone (603) 444-2464
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80301806 | Medicaid | NH |
Other names
- Ammonoosuc Community Health Services, Inc
Other providers in Warren, NH
All providers in Warren, NH · Federally Qualified Health Center (FQHC) in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.