Provider Demographics
NPI:1164626206
Name:SAU 75GRANTHAM
Entity Type:Organization
Organization Name:SAU 75GRANTHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-863-9689
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-0287
Mailing Address - Country:US
Mailing Address - Phone:603-863-9689
Mailing Address - Fax:
Practice Address - Street 1:300 RTE 10 SOUTH
Practice Address - Street 2:
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753
Practice Address - Country:US
Practice Address - Phone:603-863-9689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50500092Medicaid