MEDICARE: COUNCIL ON AGING FOR SOUTHEASTERN VT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053766584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNCIL ON AGING FOR SOUTHEASTERN VT, INC.

Provider Business Mailing Address
First Line	:	38 PLEASANT ST
Second Line	:
City	:	SPRINGFIELD
State	:	VT
Zip	:	05156-2614
Country	:	US
Telephone Number	:	802-885-2655
Fax Number	:	802-885-2665

Provider Business Practice Location Address
First Line	:	38 PLEASANT ST
Second Line	:
City	:	SPRINGFIELD
State	:	VT
Zip	:	05156-2614
Country	:	US
Telephone Number	:	802-885-2655
Fax Number	:	802-885-2665

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	RICHARD L. WOODSIDE
Credential	:
Telephone Number	:	802-885-2691

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	05/03/2016

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