Basic Information
| Provider Information | |||||||||
| NPI: | 1164636924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONDONDERRY SCHOOL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 268C MAMMOTH ROAD | ||||||||
| Address2: | |||||||||
| City: | LONDONDERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03053 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 268C MAMMOTH ROAD | ||||||||
| Address2: | |||||||||
| City: | LONDONDERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034326920 | ||||||||
| FaxNumber: | 6034251049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BALKE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PUPIL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6034326920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 50003916 | 05 | NH | MEDICAID |