Basic Information
| Provider Information | |||||||||
| NPI: | 1215143649 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONTOOCOOK VALLEY SCHOOL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CONVAL SCHOOL DISTRICT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 HANCOCK ROAD | ||||||||
| Address2: | |||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039247503 | ||||||||
| FaxNumber: | 6039240070 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 HANCOCK RD | ||||||||
| Address2: | |||||||||
| City: | PETERBOROUGH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034581109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039247503 | ||||||||
| FaxNumber: | 6039240070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | O CONNOR | ||||||||
| AuthorizedOfficialFirstName: | JERILYNN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT SPECIAL ED | ||||||||
| AuthorizedOfficialTelephone: | 6039247503 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 50001000 | 05 | NH | MEDICAID |