Provider Demographics
NPI:1376756957
Name:GILMANTON SCHOOL DISTRICT SAU 79
Entity Type:Organization
Organization Name:GILMANTON SCHOOL DISTRICT SAU 79
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-267-9097
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-0309
Mailing Address - Country:US
Mailing Address - Phone:603-267-9097
Mailing Address - Fax:
Practice Address - Street 1:1386 NH ROUTE 140
Practice Address - Street 2:
Practice Address - City:GILMANTON IRON WORKS
Practice Address - State:NH
Practice Address - Zip Code:03837-4630
Practice Address - Country:US
Practice Address - Phone:603-364-5681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50003000Medicaid