Healthcare Provider Details

I. General information

NPI: 1598153322
Provider Name (Legal Business Name): CCK HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2015
Last Update Date: 01/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FOREST HILL DR
SAINT ALBANS VT
05478-1615
US

IV. Provider business mailing address

110 FAIRFAX RD
SAINT ALBANS VT
05478-6299
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-3498
  • Fax: 802-524-3071
Mailing address:
  • Phone: 802-752-1600
  • Fax: 802-752-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateVT

VIII. Authorized Official

Name: MRS. COLEEN CONDON KOHAUT
Title or Position: MANAGING MEMBER
Credential: NHA
Phone: 802-752-1600