Provider Demographics
NPI:1255337473
Name:CARLOS G. OTIS HEALTH CARE CENTER INC.
Entity type:Organization
Organization Name:CARLOS G. OTIS HEALTH CARE CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-365-3601
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353
Mailing Address - Country:US
Mailing Address - Phone:802-365-3601
Mailing Address - Fax:802-365-9500
Practice Address - Street 1:185 GRAFTON RD
Practice Address - Street 2:
Practice Address - City:TOWNSHEND
Practice Address - State:VT
Practice Address - Zip Code:05353
Practice Address - Country:US
Practice Address - Phone:802-365-7920
Practice Address - Fax:802-365-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0471300Medicaid
VT0471300Medicaid