1821722125 NPI number — VALLEY VIEW AT COTTAGE STREET, LLC

Table of content: (NPI 1821722125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821722125 NPI number — VALLEY VIEW AT COTTAGE STREET, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY VIEW AT COTTAGE STREET, LLC
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:
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:
1821722125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRLEE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05045-0093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-333-4829
Provider Business Mailing Address Fax Number:
802-333-7091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 COTTAGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-333-4829
Provider Business Practice Location Address Fax Number:
802-333-7091
Provider Enumeration Date:
07/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PUSHEE
Authorized Official First Name:
DYLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SINGLE MEMBER
Authorized Official Telephone Number:
802-333-4829

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com