Healthcare Provider Details

I. General information

NPI: 1508936733
Provider Name (Legal Business Name): VERGENNES RESIDENTIAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 NORTH ST
VERGENNES VT
05491-1108
US

IV. Provider business mailing address

34 NORTH ST
VERGENNES VT
05491-1108
US

V. Phone/Fax

Practice location:
  • Phone: 802-877-3562
  • Fax: 802-877-3562
Mailing address:
  • Phone: 802-877-3562
  • Fax: 802-877-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number0311
License Number StateVT

VIII. Authorized Official

Name: MR. TIMOTHY F BUSKEY SR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 802-877-3562