Provider Demographics
NPI:1245443456
Name:OXBOW SENIOR INDEPENDENCE PROGRAM, INC.
Entity type:Organization
Organization Name:OXBOW SENIOR INDEPENDENCE PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-866-5465
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-0025
Mailing Address - Country:US
Mailing Address - Phone:802-866-5465
Mailing Address - Fax:802-866-5465
Practice Address - Street 1:4621 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05051-0025
Practice Address - Country:US
Practice Address - Phone:802-866-5465
Practice Address - Fax:802-866-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care