Provider Demographics
NPI:1659406148
Name:BROWNWAY RESIDENCE
Entity Type:Organization
Organization Name:BROWNWAY RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-933-2315
Mailing Address - Street 1:328 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ENOSBURG FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05450-5500
Mailing Address - Country:US
Mailing Address - Phone:802-933-2315
Mailing Address - Fax:802-933-7997
Practice Address - Street 1:328 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ENOSBURG FALLS
Practice Address - State:VT
Practice Address - Zip Code:05450-5500
Practice Address - Country:US
Practice Address - Phone:802-933-2315
Practice Address - Fax:802-933-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0118311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W052Medicaid
VT047W106Medicaid