Provider Demographics
NPI:1477680189
Name:ORANGE COUNTY PARENT CHILD CENTER
Entity Type:Organization
Organization Name:ORANGE COUNTY PARENT CHILD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:802-685-2264
Mailing Address - Street 1:361 VT RTE 110
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:VT
Mailing Address - Zip Code:05038-8994
Mailing Address - Country:US
Mailing Address - Phone:802-685-2264
Mailing Address - Fax:802-685-2278
Practice Address - Street 1:361 VT RTE 110
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:VT
Practice Address - Zip Code:05038-8994
Practice Address - Country:US
Practice Address - Phone:802-685-2264
Practice Address - Fax:802-685-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010980Medicaid