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General NPI Number Information
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NPI Number | 1174656201
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Entity Type | Organization
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Legal Business Name | NORTHERN COUNTIES HEALTH CARE, INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 161 SHERMAN DRVIE
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City | ST. JOHNSBURY
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State | VT
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Zip | 05819
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Country | US
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Telephone | 802-748-8116
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Fax | 802-748-4628
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Provider Business Mailing Address
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Address Line | 161 SHERMAN DRVIE
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City | ST. JOHNSBURY
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State | VT
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Zip | 05819
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Country | US
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Telephone | 802-748-8116
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Fax | 802-748-4628
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Authorized Official
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Title or Position | INTERIM EXECUTIVE DIRECTOR
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Name | MR. JACK DONNELLY
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Credential |
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Telephone | 802-748-9405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | VT
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