Healthcare Provider Details

I. General information

NPI: 1154775104
Provider Name (Legal Business Name): MARANATHA NATURAL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WEATHERHEAD HOLLOW RD
GUILFORD VT
05301
US

IV. Provider business mailing address

1860 WEATHERHEAD HOLLOW RD
GUILFORD VT
05301-9821
US

V. Phone/Fax

Practice location:
  • Phone: 802-451-1966
  • Fax: 802-738-1066
Mailing address:
  • Phone: 802-451-1966
  • Fax: 802-738-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number101.0119517
License Number StateVT

VIII. Authorized Official

Name: MS. GABRIELLA NEACSU KATZ
Title or Position: OWNER
Credential: FNP-BC
Phone: 802-451-1966