1568448074 NPI number — LAMOILLE HOME HEALTH AGENCY, INC.

Table of content: (NPI 1568448074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568448074 NPI number — LAMOILLE HOME HEALTH AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAMOILLE HOME HEALTH AGENCY, INC.
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:
1568448074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 FARR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05661-9181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-888-4651
Provider Business Mailing Address Fax Number:
802-888-0062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 FARR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05661-9181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-888-4651
Provider Business Practice Location Address Fax Number:
802-888-0062
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEMARS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
802-888-4651

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0477015 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1004589 . This is a "HBK&F" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1004855 . This is a "TBI" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1004913 . This is a "HI-TECH MEDICAID" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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