Healthcare Provider Details

I. General information

NPI: 1427261312
Provider Name (Legal Business Name): TERRACE COMMUNITIES WOODSTOCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 WOODSTOCK RD
WOODSTOCK VT
05091-9759
US

IV. Provider business mailing address

456 WOODSTOCK ROAD
WOODSTOCK VT
05091
US

V. Phone/Fax

Practice location:
  • Phone: 802-457-2228
  • Fax:
Mailing address:
  • Phone: 802-457-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1005
License Number StateVT

VIII. Authorized Official

Name: DEANNE SHERROD
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 802-457-2228