Provider Demographics
NPI:1235586074
Name:SOUTHWESTERN VERMONT COUNCIL ON AGING, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN VERMONT COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:802-786-5990
Mailing Address - Street 1:1085 US ROUTE 4 E
Mailing Address - Street 2:UNIT 2B
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-8860
Mailing Address - Country:US
Mailing Address - Phone:802-786-5990
Mailing Address - Fax:
Practice Address - Street 1:1085 US ROUTE 4E
Practice Address - Street 2:UNIT 2B
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-0000
Practice Address - Country:US
Practice Address - Phone:802-786-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W024Medicaid