Healthcare Provider Details

I. General information

NPI: 1134604622
Provider Name (Legal Business Name): LITTLE RIVERS HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OXBOW DR
BRADFORD VT
05033-9037
US

IV. Provider business mailing address

PO BOX 8
NEWBURY VT
05051-0008
US

V. Phone/Fax

Practice location:
  • Phone: 802-757-2325
  • Fax: 802-757-3215
Mailing address:
  • Phone: 802-439-5321
  • Fax: 802-439-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREW BARTER
Title or Position: CEO
Credential:
Phone: 802-222-4637