Provider Demographics
NPI:1629554761
Name:LITTLE RIVERS HEALTH CARE, INC.
Entity Type:Organization
Organization Name:LITTLE RIVERS HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:AUCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MSM-HCA, BSN, RN
Authorized Official - Phone:802-222-4637
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0338
Mailing Address - Country:US
Mailing Address - Phone:802-222-4637
Mailing Address - Fax:802-222-5674
Practice Address - Street 1:2420 ROUTE 302
Practice Address - Street 2:
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081-9750
Practice Address - Country:US
Practice Address - Phone:802-757-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE RIVERS HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1316165129Medicaid