Provider Demographics
NPI:1689661365
Name:MAYO HEALTHCARE INC
Entity Type:Organization
Organization Name:MAYO HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LNHA
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-485-3161
Mailing Address - Street 1:71 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05663-5644
Mailing Address - Country:US
Mailing Address - Phone:802-485-3161
Mailing Address - Fax:802-485-6307
Practice Address - Street 1:71 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5644
Practice Address - Country:US
Practice Address - Phone:802-485-3161
Practice Address - Fax:802-485-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0475053Medicaid
VT475053Medicare Oscar/Certification