Provider Demographics
NPI:1649479338
Name:LAMOILLE AREA ADULT DAY CARE CENTER
Entity type:Organization
Organization Name:LAMOILLE AREA ADULT DAY CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-7045
Mailing Address - Street 1:11 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-6095
Mailing Address - Country:US
Mailing Address - Phone:802-888-7045
Mailing Address - Fax:802-888-8809
Practice Address - Street 1:11 COURT ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-6095
Practice Address - Country:US
Practice Address - Phone:802-888-7045
Practice Address - Fax:802-888-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W021MedicaidMEDICAID PROVIDER ID