Healthcare Provider Details

I. General information

NPI: 1457781031
Provider Name (Legal Business Name): GIFFORD HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 VT RTE110
CHELSEA VT
05038-8993
US

IV. Provider business mailing address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

V. Phone/Fax

Practice location:
  • Phone: 802-685-4400
  • Fax: 802-685-4329
Mailing address:
  • Phone: 802-728-7000
  • Fax: 802-728-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateVT

VIII. Authorized Official

Name: MICHAEL K COSTA
Title or Position: CEO
Credential:
Phone: 802-728-2211