Provider Demographics
NPI:1740650977
Name:NORTHEAST PASSAGE PROGRAM OF THE UNIVERSITY OF NEW HAMPSHIRE
Entity type:Organization
Organization Name:NORTHEAST PASSAGE PROGRAM OF THE UNIVERSITY OF NEW HAMPSHIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVINK
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS/L
Authorized Official - Phone:603-862-0070
Mailing Address - Street 1:4 LIBRARY WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3520
Mailing Address - Country:US
Mailing Address - Phone:603-862-0070
Mailing Address - Fax:603-862-0249
Practice Address - Street 1:4 LIBRARY WAY
Practice Address - Street 2:G-1 HEWITT HALL
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3520
Practice Address - Country:US
Practice Address - Phone:603-862-0070
Practice Address - Fax:603-862-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty