Healthcare Provider Details

I. General information

NPI: 1457497372
Provider Name (Legal Business Name): HOLTON HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 WESTERN AVE
BRATTLEBORO VT
05301-6089
US

IV. Provider business mailing address

158 WESTERN AVE
BRATTLEBORO VT
05301-6089
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-4155
  • Fax: 802-254-1349
Mailing address:
  • Phone: 802-254-4155
  • Fax: 802-254-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number48
License Number StateVT

VIII. Authorized Official

Name: CINDY JEROME
Title or Position: ADMINISTRATOR
Credential:
Phone: 802-254-4155