Provider Demographics
NPI:1043334626
Name:STATE OF NEW HAMPSHIRE
Entity type:Organization
Organization Name:STATE OF NEW HAMPSHIRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR TRANSITIONAL HOUSING SERVI
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:D'OVIDIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:603-271-5390
Mailing Address - Street 1:99 PLEASANT ST
Mailing Address - Street 2:HOWARD RECREATION CENTER
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3852
Mailing Address - Country:US
Mailing Address - Phone:603-271-5261
Mailing Address - Fax:603-271-5729
Practice Address - Street 1:99 PLEASANT ST
Practice Address - Street 2:HOWARD RECREATION CENTER
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3852
Practice Address - Country:US
Practice Address - Phone:603-271-5261
Practice Address - Fax:603-271-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005102Medicaid
NH99590015Medicaid