Provider Demographics
NPI:1720365125
Name:GOOD NEIGHBOR HEALTH CLINIC
Entity Type:Organization
Organization Name:GOOD NEIGHBOR HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HILDEGARDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OJIBWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-295-1868
Mailing Address - Street 1:70 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-7061
Mailing Address - Country:US
Mailing Address - Phone:802-295-1868
Mailing Address - Fax:802-295-3600
Practice Address - Street 1:70 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7061
Practice Address - Country:US
Practice Address - Phone:802-295-1868
Practice Address - Fax:802-295-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005381261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health