Provider Demographics
NPI:1932284395
Name:THE CONVERSE HOME
Entity Type:Organization
Organization Name:THE CONVERSE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-862-0401
Mailing Address - Street 1:272 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8452
Mailing Address - Country:US
Mailing Address - Phone:802-862-0401
Mailing Address - Fax:802-864-4932
Practice Address - Street 1:272 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8452
Practice Address - Country:US
Practice Address - Phone:802-862-0401
Practice Address - Fax:802-864-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT121311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W209OtherEDS-ERC
VT047W208OtherEDS-ACCS