Provider Demographics
NPI:1871634352
Name:FOUR C'S INC.
Entity Type:Organization
Organization Name:FOUR C'S INC.
Other - Org Name:HOLIDAY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:KARA
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:802-524-2996
Mailing Address - Street 1:642 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-8014
Mailing Address - Country:US
Mailing Address - Phone:802-524-2996
Mailing Address - Fax:802-524-7634
Practice Address - Street 1:642 SHELDON RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-8014
Practice Address - Country:US
Practice Address - Phone:802-524-2996
Practice Address - Fax:802-524-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0541311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W245Medicaid
VT047W246Medicaid
VT047R036Medicaid