1053754275 NPI number — MH HEALTH CARE SERVICES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053754275 NPI number — MH HEALTH CARE SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MH HEALTH CARE SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053754275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 WINOOSKI FALLS WAY STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINOOSKI
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05404-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-857-0400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5650 MAIN ST
Provider Second Line Business Practice Location Address:
C/O VCS HEALTH CENTER
Provider Business Practice Location Address City Name:
MANCHESTER CENTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05255-9711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-776-3670
Provider Business Practice Location Address Fax Number:
802-857-0498
Provider Enumeration Date:
04/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LAYMAN
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE MEDICAL OFFICER
Authorized Official Telephone Number:
317-727-8698

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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