Provider Demographics
NPI:1386856979
Name:TERRACE COMMUNITIES NORWICH, LLC
Entity Type:Organization
Organization Name:TERRACE COMMUNITIES NORWICH, LLC
Other - Org Name:VALLEY TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-304-6611
Mailing Address - Street 1:2820 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9822
Mailing Address - Country:US
Mailing Address - Phone:802-280-1910
Mailing Address - Fax:
Practice Address - Street 1:2820 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9822
Practice Address - Country:US
Practice Address - Phone:802-280-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004OtherSTATE LICENSE
VT1004OtherSTATE LICENSE