Provider Demographics
NPI:1457497372
Name:HOLTON HOME, INC.
Entity Type:Organization
Organization Name:HOLTON HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-254-4155
Mailing Address - Street 1:158 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6089
Mailing Address - Country:US
Mailing Address - Phone:802-254-4155
Mailing Address - Fax:802-254-1349
Practice Address - Street 1:158 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6089
Practice Address - Country:US
Practice Address - Phone:802-254-4155
Practice Address - Fax:802-254-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT48311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W123Medicaid
VT047W043Medicaid
VT047R020Medicaid