Provider Demographics
NPI:1134731185
Name:STATE OF NEW HAMPSHIRE
Entity type:Organization
Organization Name:STATE OF NEW HAMPSHIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPECIALIST 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 1:121 S FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2412
Mailing Address - Country:US
Mailing Address - Phone:603-271-5778
Mailing Address - Fax:603-271-5236
Practice Address - Street 1:121 S FRUIT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2412
Practice Address - Country:US
Practice Address - Phone:603-271-5778
Practice Address - Fax:603-271-5236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW HAMPSHIRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1861491334OtherNPI