MEDICARE: GREEN MOUNTAIN SUPPORT 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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649838533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN MOUNTAIN SUPPORT SERVICES INC.

Provider Business Mailing Address
First Line	:	93 JAMES RD
Second Line	:
City	:	MORRISVILLE
State	:	VT
Zip	:	05661-8790
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 JAMES RD
Second Line	:
City	:	MORRISVILLE
State	:	VT
Zip	:	05661-8790
Country	:	US
Telephone Number	:	802-888-7602
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOSHUA SMITH
Credential	:
Telephone Number	:	802-888-7602

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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