Provider Demographics
NPI:1124185459
Name:SPECIAL SERVICES TRANSPORTATION AGENCY
Entity Type:Organization
Organization Name:SPECIAL SERVICES TRANSPORTATION AGENCY
Other - Org Name:SSTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-878-1527
Mailing Address - Street 1:2091 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7651
Mailing Address - Country:US
Mailing Address - Phone:802-878-1527
Mailing Address - Fax:
Practice Address - Street 1:2091 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-7651
Practice Address - Country:US
Practice Address - Phone:802-878-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001700Medicaid