Provider Demographics
NPI:1649314287
Name:CATHEDRAL SQUARE CORPORATION
Entity type:Organization
Organization Name:CATHEDRAL SQUARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROSECLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-863-2224
Mailing Address - Street 1:308 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4740
Mailing Address - Country:US
Mailing Address - Phone:802-863-2224
Mailing Address - Fax:802-863-6661
Practice Address - Street 1:3 CATHEDRAL SQ
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4429
Practice Address - Country:US
Practice Address - Phone:802-863-3868
Practice Address - Fax:802-863-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W224Medicaid
VT047W223Medicaid