Provider Demographics
NPI:1043567977
Name:STATE OF VERMONT
Entity Type:Organization
Organization Name:STATE OF VERMONT
Other - Org Name:VERMONT PSYCHIATRIC CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL DIRECTOR IV
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-241-0118
Mailing Address - Street 1:280 STATE DRIVE
Mailing Address - Street 2:NOB 2 NORTH
Mailing Address - City:WATERBARY
Mailing Address - State:VT
Mailing Address - Zip Code:05671-2010
Mailing Address - Country:US
Mailing Address - Phone:802-241-0090
Mailing Address - Fax:802-828-3823
Practice Address - Street 1:350 FISHER ROAD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05633-7901
Practice Address - Country:US
Practice Address - Phone:802-828-3300
Practice Address - Fax:802-828-2587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF VERMONT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital