Provider Demographics
NPI:1861491334
Name:STATE OF NEW HAMPSHIRE
Entity Type:Organization
Organization Name:STATE OF NEW HAMPSHIRE
Other - Org Name:NEW HAMPSHIRE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SPECIALILST IV
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-271-5778
Mailing Address - Street 1:36 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2359
Mailing Address - Country:US
Mailing Address - Phone:603-271-5847
Mailing Address - Fax:603-271-5845
Practice Address - Street 1:36 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2359
Practice Address - Country:US
Practice Address - Phone:603-271-5383
Practice Address - Fax:603-271-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2022-10-12
Deactivation Date:2022-07-29
Deactivation Code:
Reactivation Date:2022-08-23
Provider Licenses
StateLicense IDTaxonomies
NH283Q00000X, 323P00000X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076701Medicaid
NH3079679Medicaid
NH304001OtherMED A PROVIDER
NHRE1969Medicare ID - Type UnspecifiedMED B PSYCH
NH30003470Medicaid
NH30003469Medicaid