Provider Demographics
NPI:1811232333
Name:GREEN MOUNTAIN OASIS
Entity Type:Organization
Organization Name:GREEN MOUNTAIN OASIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-447-2900
Mailing Address - Street 1:469 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:469 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2159
Practice Address - Country:US
Practice Address - Phone:802-447-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty