Provider Demographics
NPI:1346386463
Name:BRATTLEBORO AREA ADULT DAY SERVICES, INC.
Entity Type:Organization
Organization Name:BRATTLEBORO AREA ADULT DAY SERVICES, INC.
Other - Org Name:THE GATHERING PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FREDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-246-1511
Mailing Address - Street 1:30 TERRACE STREET
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-0000
Mailing Address - Country:US
Mailing Address - Phone:802-254-6559
Mailing Address - Fax:802-257-2859
Practice Address - Street 1:30 TERRACE STREET
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-0000
Practice Address - Country:US
Practice Address - Phone:802-254-6559
Practice Address - Fax:802-257-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTCERTIFIED - #0313261QA0600X
VT261QA0600X, 261QR0400X
VT047W138261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W038Medicaid
VT047W032Medicaid
VT047W138Medicaid
NH30583033Medicaid