Provider Demographics
NPI:1306058664
Name:PORTSMOUTH SCHOOL DEPARTMENT
Entity type:Organization
Organization Name:PORTSMOUTH SCHOOL DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADRAVEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-431-5080
Mailing Address - Street 1:1 JUNKINS AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-431-5080
Mailing Address - Fax:603-431-6753
Practice Address - Street 1:1 JUNKINS AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-5080
Practice Address - Fax:603-431-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLEA - 251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50005201Medicaid