Healthcare Provider Details

I. General information

NPI: 1982897203
Provider Name (Legal Business Name): MOUNTAIN VALLEY HEALTH COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 RTE 11
LONDONDERRY VT
05148-0310
US

IV. Provider business mailing address

PO BOX 310
LONDONDERRY VT
05148-0310
US

V. Phone/Fax

Practice location:
  • Phone: 802-824-6901
  • Fax: 802-824-3602
Mailing address:
  • Phone: 802-824-6901
  • Fax: 802-824-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LITCHFIELD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 802-824-6901