Provider Demographics
NPI:1417348509
Name:JOHN GRAHAM SHELTER
Entity Type:Organization
Organization Name:JOHN GRAHAM SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:READY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-989-2581
Mailing Address - Street 1:69 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1114
Mailing Address - Country:US
Mailing Address - Phone:802-877-2677
Mailing Address - Fax:
Practice Address - Street 1:69 MAIN ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1114
Practice Address - Country:US
Practice Address - Phone:802-877-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0099058251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management