Provider Demographics
NPI:1720528227
Name:NORTHEAST KINGDOM HUMAN SERVICES, INC
Entity Type:Organization
Organization Name:NORTHEAST KINGDOM HUMAN SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-334-7451
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-0724
Mailing Address - Country:US
Mailing Address - Phone:802-334-6744
Mailing Address - Fax:
Practice Address - Street 1:181 CRAWFORD ROAD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829-9999
Practice Address - Country:US
Practice Address - Phone:802-334-6744
Practice Address - Fax:802-334-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty