Provider Demographics
NPI:1053599274
Name:DOVER CHILDRENS HOME
Entity type:Organization
Organization Name:DOVER CHILDRENS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORALUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:603-742-4289
Mailing Address - Street 1:207 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4039
Mailing Address - Country:US
Mailing Address - Phone:603-742-4289
Mailing Address - Fax:603-742-2057
Practice Address - Street 1:207 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4039
Practice Address - Country:US
Practice Address - Phone:603-742-4289
Practice Address - Fax:603-742-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1063251S00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health