Provider Demographics
NPI:1518078666
Name:VERMONT CATHOLIC CHARITIES, INC.
Entity Type:Organization
Organization Name:VERMONT CATHOLIC CHARITIES, INC.
Other - Org Name:MICHAUD MEMORIAL MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-658-6111
Mailing Address - Street 1:55 JOY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-0000
Mailing Address - Country:US
Mailing Address - Phone:802-658-6111
Mailing Address - Fax:802-860-0451
Practice Address - Street 1:47 HERRICK ROAD
Practice Address - Street 2:
Practice Address - City:DERBY LINE
Practice Address - State:VT
Practice Address - Zip Code:05830-8759
Practice Address - Country:US
Practice Address - Phone:802-873-3152
Practice Address - Fax:802-864-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0143311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W058Medicaid
VT047W096Medicaid