Provider Demographics
NPI:1558465856
Name:LORETTO-KERVICK HOMES
Entity Type:Organization
Organization Name:LORETTO-KERVICK HOMES
Other - Org Name:VERMONT CATHOLIC CHARITIES INC
Other - Org Type:Former Legal Business Name
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 1:351 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2921
Mailing Address - Country:US
Mailing Address - Phone:802-658-6111
Mailing Address - Fax:802-860-0451
Practice Address - Street 1:131 CONVENT AVENUE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-5133
Practice Address - Fax:802-775-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0298311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTW47W182Medicaid
VT047W181Medicaid