Provider Demographics
NPI:1144602962
Name:RED CLOVER NATURAL HEALTH, INC.
Entity Type:Organization
Organization Name:RED CLOVER NATURAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:TOMAS
Authorized Official - Last Name:ARCHDEACON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:802-505-0597
Mailing Address - Street 1:174 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3827
Mailing Address - Country:US
Mailing Address - Phone:802-505-0597
Mailing Address - Fax:802-223-2016
Practice Address - Street 1:174 RIVER ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3827
Practice Address - Country:US
Practice Address - Phone:802-505-0597
Practice Address - Fax:802-223-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT171100000X
VT0990000239175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty