NPIMap

Organization Active NPI

Ammonoosuc Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Warren, NH
National Provider Identifier
1982821765
Registry record updated Mar 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AMMONOOSUC COMMUNITY HEALTH SERVICES, INC
Doing business as
Ammonoosuc Community Health Services, Inc
Practice address
333 Nhroute 25
Warren, NH 03279-4431
Phone
(603) 764-5704
NPI assigned
Apr 20, 2007
Last updated
Mar 16, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
AMMONOOSUC COMMUNITY HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2009

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

Authorized official

Name
Mr. Edward D Shanshala II
Title
Director
Phone
(603) 444-2464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 names 1

  • Ammonoosuc Community Health Services, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080228000543 NH Part A Provider - Federally Qualified Health Center (FQHC) 1052361664 Practice locations: Warren, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982821765. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 24, 1975 in NH
Enrollment address
333 NH Route 25
Warren, NH 32794431

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ammonoosuc Community He7 organizations share this tax ID, including this one
Part of
Ammonoosuc Community He

Other organizations with this tax ID 6

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

Locations

1095 Profile Rd
#B
Franconia, NH 03580
Phone (603) 823-7078

14 King Sq
Whitefield, NH 03598
Phone (603) 837-2333

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark Secord Individual Corporate DirectorBoard Member-Vice President Jul 1, 2012
Edward Shanshala Individual Corporate OfficerCeo Oct 1, 2008
W-2 Managing EmployeeCeo Oct 1, 2008
Operational/Managerial ControlCeo Oct 1, 2008
Robert Tortorice Individual Corporate Director Dec 10, 2008
John Rapoport Individual Corporate DirectorBoard Member Jul 1, 2014
Elizabeth F Harman Individual Corporate DirectorBoard Member Jan 1, 2015
Gary Merchant Individual Corporate DirectorBoard Member Jan 1, 2016
Edward Densmore Individual Corporate DirectorBoard Member Jul 1, 2012
Erik Becker Individual Corporate DirectorBoard Member Jan 1, 2017
Kenneth Riebel Individual Corporate OfficerCfo Feb 22, 2008
W-2 Managing EmployeeCfo Feb 22, 2008
Ivy Pearon Individual Corporate DirectorBoard Member Jan 1, 2017
Doug Harman Individual Corporate DirectorBoard Member -President Jul 1, 2015

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1982821765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MOUNT EUSTIS RD",
            "city": "LITTLETON",
            "state": "NH",
            "postal_code": "035613712",
            "telephone_number": "603-444-2464",
            "fax_number": "603-444-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 NHROUTE 25",
            "city": "WARREN",
            "state": "NH",
            "postal_code": "032794431",
            "telephone_number": "603-764-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMMONOOSUC COMMUNITY HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMMONOOSUC COMMUNITY HEALTH SERVICES, INC",
        "enumeration_date": "2007-04-20",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "SHANSHALA II",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "603-444-2464",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ammonoosuc Community Health Services, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, NH

Sources for this page

Verify at the official NPI Registry.