Healthcare Provider Details

I. General information

NPI: 1508080334
Provider Name (Legal Business Name): GREEN MOUNTAIN ADULT DAY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 PROUTY DR
NEWPORT VT
05855-9513
US

IV. Provider business mailing address

148 PROUTY DR
NEWPORT VT
05855-9513
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-3188
  • Fax: 802-334-3188
Mailing address:
  • Phone: 802-334-3188
  • Fax: 802-334-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID L SILVER
Title or Position: MANAGER
Credential:
Phone: 802-334-7321