Provider Demographics
NPI:1669645644
Name:LAMOILLE FAMILY CENTER
Entity Type:Organization
Organization Name:LAMOILLE FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-5229
Mailing Address - Street 1:480 CADYS FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9137
Mailing Address - Country:US
Mailing Address - Phone:802-888-5229
Mailing Address - Fax:802-888-5392
Practice Address - Street 1:480 CADYS FALLS RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9137
Practice Address - Country:US
Practice Address - Phone:802-888-5229
Practice Address - Fax:802-888-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0890000651251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010297Medicaid