MEDICARE: NORTHEAST KINGDOM HUMAN SERVICES INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1043372709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST KINGDOM HUMAN SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 724
Second Line	:
City	:	NEWPORT
State	:	VT
Zip	:	05855-0724
Country	:	US
Telephone Number	:	802-334-6744
Fax Number	:	802-334-7340

Provider Business Practice Location Address
First Line	:	181 CRAWFORD RD
Second Line	:
City	:	NEWPORT
State	:	VT
Zip	:	05855-6405
Country	:	US
Telephone Number	:	802-334-6744
Fax Number	:	802-334-7455

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. DENIS HOULE
Credential	:	MA
Telephone Number	:	802-334-6744

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	12/04/2025

181 CRAWFORD RD RM 130
NEWPORT, VT
05855-6405

Practice Phone: 802-239-1593
Practice Fax: 802-334-0107