Provider Demographics
NPI:1770614034
Name:THE MANES HOUSE INC.
Entity type:Organization
Organization Name:THE MANES HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-442-8900
Mailing Address - Street 1:127 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2406
Mailing Address - Country:US
Mailing Address - Phone:802-442-8900
Mailing Address - Fax:802-442-3438
Practice Address - Street 1:127 UNION ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2406
Practice Address - Country:US
Practice Address - Phone:802-442-8900
Practice Address - Fax:802-442-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0193302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W165Medicaid
VT047W076Medicaid