Healthcare Provider Details

I. General information

NPI: 1417958356
Provider Name (Legal Business Name): THE TRUSTEES OF THE GILL ODD FELLOWS HOME OF VERMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 GILL TER
LUDLOW VT
05149-1004
US

IV. Provider business mailing address

8 GILL TERRACE
LUDLOW VT
05149
US

V. Phone/Fax

Practice location:
  • Phone: 802-228-4571
  • Fax: 802-228-2229
Mailing address:
  • Phone: 802-228-4571
  • Fax: 802-228-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA C. SOUTHWORTH
Title or Position: NURSING HOME ADMINISTRATOR
Credential: NURSING HOME ADMINIS
Phone: 802-228-4571