Provider Demographics
NPI:1043038250
Name:GREEN MOUNTAIN TOTAL CARE
Entity type:Organization
Organization Name:GREEN MOUNTAIN TOTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, COO
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHBONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-923-3434
Mailing Address - Street 1:1375 MAPLE TREE PL # 1067
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8210
Mailing Address - Country:US
Mailing Address - Phone:802-923-3434
Mailing Address - Fax:
Practice Address - Street 1:1233 SHELBURNE RD STE 206
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7733
Practice Address - Country:US
Practice Address - Phone:802-923-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health