| NPI | 1316143142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BOLDUC Administrator 802-933-2511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: VT 0144) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2020-08-22 |