Provider Demographics
NPI:1831211606
Name:CHAMPLAIN ISLANDS PARENT-CHILD CENTER
Entity type:Organization
Organization Name:CHAMPLAIN ISLANDS PARENT-CHILD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-796-3013
Mailing Address - Street 1:22 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ALBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05440-6000
Mailing Address - Country:US
Mailing Address - Phone:802-796-3013
Mailing Address - Fax:802-796-6042
Practice Address - Street 1:22 LAKE ST
Practice Address - Street 2:
Practice Address - City:ALBURG
Practice Address - State:VT
Practice Address - Zip Code:05440-6000
Practice Address - Country:US
Practice Address - Phone:802-796-3013
Practice Address - Fax:802-796-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1005947251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)