Provider Demographics
NPI:1295954816
Name:LAMOILLE HOME HEALTH AGENCY INC.
Entity type:Organization
Organization Name:LAMOILLE HOME HEALTH AGENCY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-888-4651
Mailing Address - Street 1:54 FARR AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661
Mailing Address - Country:US
Mailing Address - Phone:802-888-4651
Mailing Address - Fax:802-888-0062
Practice Address - Street 1:54 FARR AVENUE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-4651
Practice Address - Fax:802-888-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT47W019OtherWAIVER