Provider Demographics
NPI:1215023635
Name:PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
Other - Org Name:PLANNED PARENTHOOD OF N NEW ENGLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-448-9728
Mailing Address - Street 1:128 LAKESIDE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4939
Mailing Address - Country:US
Mailing Address - Phone:802-448-9784
Mailing Address - Fax:802-660-9435
Practice Address - Street 1:128 LAKESIDE AVE
Practice Address - Street 2:STE 301
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4939
Practice Address - Country:US
Practice Address - Phone:802-448-9784
Practice Address - Fax:802-660-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0012729332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006041Medicaid
2101728OtherPK
VTVT6041Medicare ID - Type UnspecifiedVERMONT