Healthcare Provider Details

I. General information

NPI: 1528185360
Provider Name (Legal Business Name): CRAFTSBURY COMMUNITY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 E CRAFTSBURY RD
CRAFTSBURY VT
05826-9519
US

IV. Provider business mailing address

1784 E CRAFTSBURY RD
CRAFTSBURY VT
05826-9519
US

V. Phone/Fax

Practice location:
  • Phone: 802-586-2414
  • Fax: 802-586-6956
Mailing address:
  • Phone: 802-586-2414
  • Fax: 802-586-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number0292
License Number StateVT

VIII. Authorized Official

Name: LANCE W. COMFORT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 802-586-2414