Provider Demographics
NPI:1528185360
Name:CRAFTSBURY COMMUNITY CARE CENTER, INC.
Entity Type:Organization
Organization Name:CRAFTSBURY COMMUNITY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:COMFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-586-2414
Mailing Address - Street 1:1784 E CRAFTSBURY RD
Mailing Address - Street 2:
Mailing Address - City:CRAFTSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05826-9519
Mailing Address - Country:US
Mailing Address - Phone:802-586-2414
Mailing Address - Fax:802-586-6956
Practice Address - Street 1:1784 E CRAFTSBURY RD
Practice Address - Street 2:
Practice Address - City:CRAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05826-9519
Practice Address - Country:US
Practice Address - Phone:802-586-2414
Practice Address - Fax:802-586-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0292311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W090Medicaid