Provider Demographics
NPI:1326594359
Name:VERMONT HOLISTIC HEALTH PLLC
Entity Type:Organization
Organization Name:VERMONT HOLISTIC HEALTH PLLC
Other - Org Name:VERMONT HOUSECALLS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:802-293-2929
Mailing Address - Street 1:704 STAPLES RD
Mailing Address - Street 2:
Mailing Address - City:DANBY
Mailing Address - State:VT
Mailing Address - Zip Code:05739-9341
Mailing Address - Country:US
Mailing Address - Phone:802-293-2929
Mailing Address - Fax:802-419-8311
Practice Address - Street 1:5053 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9771
Practice Address - Country:US
Practice Address - Phone:802-293-2929
Practice Address - Fax:802-419-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0107976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTY400311948OtherMEDICARE
NYY400291819OtherMEDICARE
VTY400311948OtherMEDICARE