Provider Demographics
NPI:1568448074
Name:LAMOILLE HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:LAMOILLE HOME HEALTH AGENCY, INC.
Other - Org Name:LAMOILLE HOME HEALTH & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-888-4651
Mailing Address - Street 1:54 FARR AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9181
Mailing Address - Country:US
Mailing Address - Phone:802-888-4651
Mailing Address - Fax:802-888-0062
Practice Address - Street 1:54 FARR AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9181
Practice Address - Country:US
Practice Address - Phone:802-888-4651
Practice Address - Fax:802-888-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X
VT251E00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0477015Medicaid
VT1004589OtherHBK&F
VT1004855OtherTBI
VT1004913OtherHI-TECH MEDICAID
VT0477015Medicaid