MEDICARE: MANCHESTER HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1508130998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANCHESTER HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 1224
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-1224
Country	:	US
Telephone Number	:	802-362-2126
Fax Number	:	802-362-4884

Provider Business Practice Location Address
First Line	:	5468 MAIN ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9481
Country	:	US
Telephone Number	:	802-362-2126
Fax Number	:	802-362-4884

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BARBARA L KEOUGH
Credential	:	RN
Telephone Number	:	802-362-2126

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	03/02/2012

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