Provider Demographics
NPI:1760477764
Name:STATE OF NEW HAMPSHIRE
Entity Type:Organization
Organization Name:STATE OF NEW HAMPSHIRE
Other - Org Name:GLENCLIFF HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BICKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MPA NHA
Authorized Official - Phone:603-989-3111
Mailing Address - Street 1:393 HIGH ST
Mailing Address - Street 2:PO BOX 76
Mailing Address - City:GLENCLIFF
Mailing Address - State:NH
Mailing Address - Zip Code:03238-0076
Mailing Address - Country:US
Mailing Address - Phone:603-989-3111
Mailing Address - Fax:603-989-3040
Practice Address - Street 1:393 HIGH ST
Practice Address - Street 2:
Practice Address - City:GLENCLIFF
Practice Address - State:NH
Practice Address - Zip Code:03238-0076
Practice Address - Country:US
Practice Address - Phone:603-989-3111
Practice Address - Fax:603-989-3040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW HAMPSHIRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-15
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH83016951Medicaid
NHNH6951Medicare Oscar/Certification