Provider Demographics
NPI:1205040334
Name:STARK VILLAGE SCHOOL
Entity Type:Organization
Organization Name:STARK VILLAGE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-636-2492
Mailing Address - Street 1:65 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:NH
Mailing Address - Zip Code:03582-4087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1192 STARK HWY
Practice Address - Street 2:
Practice Address - City:STARK
Practice Address - State:NH
Practice Address - Zip Code:03582-6212
Practice Address - Country:US
Practice Address - Phone:603-636-1092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH50004023251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50004023Medicaid