Healthcare Provider Details

I. General information

NPI: 1508997487
Provider Name (Legal Business Name): MAYO HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WATER ST
NORTHFIELD VT
05663-5640
US

IV. Provider business mailing address

71 RICHARDSON ST
NORTHFIELD VT
05663-5644
US

V. Phone/Fax

Practice location:
  • Phone: 802-485-3161
  • Fax:
Mailing address:
  • Phone: 802-485-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number0199
License Number StateVI

VIII. Authorized Official

Name: MS. LOIS A LUSIGNAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 802-485-3161