Provider Demographics
NPI:1013562636
Name:FIVE-TOWN HEALTH ALLIANCE, INC
Entity type:Organization
Organization Name:FIVE-TOWN HEALTH ALLIANCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MELBOSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-453-5116
Mailing Address - Street 1:61 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1043
Mailing Address - Country:US
Mailing Address - Phone:802-453-3911
Mailing Address - Fax:
Practice Address - Street 1:61 PINE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1043
Practice Address - Country:US
Practice Address - Phone:802-453-3911
Practice Address - Fax:802-453-2358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE-TOWN HEALTH ALLIANCE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-09
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty