Provider Demographics
NPI:1508997487
Name:MAYO HEALTHCARE INC
Entity Type:Organization
Organization Name:MAYO HEALTHCARE INC
Other - Org Name:MAYO MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUSIGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-485-3161
Mailing Address - Street 1:71 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05663-5644
Mailing Address - Country:US
Mailing Address - Phone:802-485-3161
Mailing Address - Fax:
Practice Address - Street 1:610 WATER ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5640
Practice Address - Country:US
Practice Address - Phone:802-485-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI0199311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W056Medicaid