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General NPI Number Information
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NPI Number | 1386581775
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Entity Type | Organization
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Legal Business Name | IDA'S HOUSE OF VERMONT PROFESSIONAL LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 05/02/2026
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Last Update Date | 05/02/2026
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Provider Practice Location Address
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Address Line | 360 NEW RD
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City | BRANDON
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State | VT
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Zip | 05733-8396
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Country | US
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Telephone | 802-247-0381
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Fax | 888-502-6598
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Provider Business Mailing Address
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Address Line | 360 NEW RD
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City | BRANDON
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State | VT
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Zip | 05733-8396
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Country | US
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Telephone | 802-247-0381
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Fax | 888-502-6598
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Authorized Official
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Title or Position | OWNER
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Name | DR. TINEY RAY
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Credential | PHD, DNP, FNP,PMHNP
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Telephone | 678-701-4679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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