| NPI | 1255879912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELINE BAKER Cota 802-747-6456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: VT 073.0123765) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |