Healthcare Provider Details

I. General information

NPI: 1477664530
Provider Name (Legal Business Name): LORETTO-KERVICK HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MEADOW ST
RUTLAND VT
05701-3965
US

IV. Provider business mailing address

351 NORTH AVE
BURLINGTON VT
05401-2921
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-8840
  • Fax: 802-773-9638
Mailing address:
  • Phone: 802-658-6110
  • Fax: 802-860-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number0138
License Number StateVT

VIII. Authorized Official

Name: MRS. DENISE M PAYEA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 802-658-6111