Healthcare Provider Details

I. General information

NPI: 1033886502
Provider Name (Legal Business Name): NORTHEAST KINGDOM HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 2ND ST
NEWPORT VT
05855-2185
US

IV. Provider business mailing address

PO BOX 250
NEWPORT VT
05855-0250
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-7604
  • Fax:
Mailing address:
  • Phone: 802-895-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELAINE GAY LOCKWOOD
Title or Position: PRESIDENT
Credential:
Phone: 802-895-4994