Provider Demographics
NPI:1114142825
Name:ROXANNE HANSON LADABOUCHE
Entity Type:Organization
Organization Name:ROXANNE HANSON LADABOUCHE
Other - Org Name:GIORDANO MANOR COMMUNITY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADABOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:802-868-3903
Mailing Address - Street 1:34 CANADA ST
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-1041
Mailing Address - Country:US
Mailing Address - Phone:802-868-3903
Mailing Address - Fax:802-868-4339
Practice Address - Street 1:34 CANADA ST
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-1041
Practice Address - Country:US
Practice Address - Phone:802-868-3903
Practice Address - Fax:802-868-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0038311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W157Medicaid